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  1. deny121375

    Woes of A Foreign Nurse

    I was only 29 years old when I came here to work as a nurse. I was what they call a "foreign nurse". I was born and raised in the Philippines and was fortunate to land a job in one of the hospitals in Upstate New York. To get the job, I applied through an agency in the Philippines. It was not easy to apply, I was not hired right away. It took me 2 years to meet the requirements so I could come here. I needed to pass three to four tests to qualify: TSE (Test for Spoken English) exam, TOEFL (Test of English as a Foreign Language), CGFNS (Commission on Graduates of Foreign Nursing Schools) exam so I can get a VISA screen certificate, and lastly the NCLEX (National Council Licensure Examination) so I can get my nursing license to practice here in US. Not all who applied were fortunate, some were not able to complete all the requirements because of financial constraints. The tests I mentioned were not free; one has to pay in dollars. Coming from a third world country, paying in dollars is a huge amount of money. Our Philippine currency is so small and insignificant compared to the US dollar. I know some of my friends who applied had to sell their lands or get a big loan from the bank just to pay the fees, but it was still not a guarantee to get the job; one has to pass all the tests. My dad who worked outside the country provided me with the financial support I need. Without him I wouldn't be able to afford to pay for them. My port of entry was in Detroit. It was an ordeal for me to find the next flight and to ask for directions as it was my first travel outside the country. Though I studied and passed the English language test, I wasn't prepared for the language and culture shock. When I arrived in upstate NY I didn't know anyone - I have no family, no relatives, no friends. I only have a thousand dollars in my pocket and relying on the job contract that I signed - a contract for 2 and 1/2 years in the hospital. Included in the contract was a temporary housing for 6 months with a low rent fee, then after 6 months I was on my own to find a place to stay. I met and gained some friends and little by little I was adapting to my new environment. My friends back home told me I was living the American dream but it was far from that...my early years here in the US were not a bed of roses. So I started working as a nurse extern; though I passed my NCLEX I was not given the full responsibility of a nurse because I lacked training. The hospital was kind enough to fill the lack by setting up training sessions in between my duties. If there is a word beyond exhaustion, that was what I felt every time my day ended. As a "foreign nurse" the major challenge was the equipment. The gadgets were amazing, top of the line, and cost a lot of money. Every where I looked all rooms were fully equipped with different machines. There were lots of beeping sounds and endless supplies of medical necessities. It was intimidating at first; I wasn't use to these machines but I had to adapt in order for me to learn. I needed to push myself more and get out of my comfort zone or else I would fail. And in my vocabulary, there is no word for fail. I have no one to support me, to motivate me...just me. I needed to survive because what I call home was a thousand miles away from here and going back is not an option, I don't have the money for the plane fare. Not all I worked with were accommodating, understanding and had the patience to work for a "foreign nurse" like me. While others took time to slow down their pace so I could catch up, others treat me as someone who shouldn't be here because when it comes to the machines, I admit I was clueless and awkward. Not only did I struggle in this aspect, I also had difficulty with the language barrier. I speak and understand English but I wasn't used to speak and hearing the language 24/7 a day. I could feel my brain and my mouth shut down after a couple of hours talking in a different language. It was harder to absorb, to comprehend what was being said, to concentrate on my tasks and to follow instructions. Add anxiety and nervousness to the picture and I was a bundle of nerves everyday. It was evident in my dealings with my colleagues and patients that one nurse rudely said to me, "Why are you torturing yourself? Just go back to where you came from because you can't do this." That was the first time I cried myself to sleep because it was partly true. I was subjecting myself to physical and mental torture, trying to stretch my limit to fit in but I knew I can do this. I couldn't count how many times I cried in silence but surprisingly, I was like a barnacle who refused to get dislodged from my goal. I was determined to succeed, it was do or die. My efforts paid off, my manager saw some potentials in me and she allowed me to train in a step-down unit in the Neuroscience department. I gained my full RN title and trained with Neurology and Neurosurgery cases. From the arterial lines, JP drains, ICP measuring, tube feeds, and drips, I was soaring high and I was making my mark as a "foreign nurse". I wasn't the same after my training, a lot had changed within me. I was more knowlegable, more confident, tougher, and more mature. I learned to detach myself from my emotion so I wouldn't feel nostalgic for my family back home, to survive the criticisms and to accept change. This part of acceptance made my transition easier. Looking back, I have come so far from that 29 year old green horn who came for an overseas nursing job. The experiences, the hardships, the criticisms both negative and positive will always be with me. I just hope whoever reads this article will be more supportive of the "foreign nurses" that will grace their path. May you be one of those people who inspires and motivates just like the ones I met who made my transition more meaningful and with ease. Because just like everyone else, we want to fit in and be successful in our chosen career no matter how different we are.
  2. Once upon a time, I encountered the most unexpected milestone of my life... I still find it a blessing that after 4 years, I was able to sacrifice my time and effort to leave California and adjust to life in the Philippines. I still remember my first day as a college freshman. I was sitting in the little wooden desk, waiting for my first subject, Psychology to start. It was a noisy environment. The other students in the room seemed to know each other by name. I anxiously sat as I pretended to mind my own business. I did not understand everything they were saying to each other. Next thing I knew, someone turned to me and frantically said "Tignan mo nga yun blush-on ko..parang na sampal ba ako?" (Look at my blush on, does it look like someone slapped me?) I interpreted that maybe she meant "Does my blush look okay?" I nodded with delight only to find out that my reaction was probably not the reaction she expected. It was only when each student introduced themselves to the class that everyone found out I was not raised in the Philippines. "Hi. My name is Lyzah and I'm from San Francisco." The room became so quiet that I could hear the air being blown out from the air condition. Next thing I knew, my fellow classmates put their index fingers under their nose as if pretending to wipe it. That's when I first discovered the term 'nosebleed' or otherwise the term used for those with foreign tongues. The first few years of my journey were the most difficult. I felt like I went back to my infant years of separation anxiety. It was tough to deal with being a Pacific Ocean away from my family and friends. I filled in the void by keeping myself busy with studies. Every morning when I woke up and at night before I went to sleep, I would remind myself that God gave me another day to live for a reason. Every day, God had a purpose for me. I learned to appreciate my culture. I will never forget the time when I had my first community immersion in Nueva Ejica. I learned how to clean and fry tilapia fish. I pumped my own bath water from the community well every 2 am in the morning. At night, I would sleep on the floor and make little forts with the help of my other batch mates as to prevent little bugs from falling on us. I do not really have a fear of bugs, but I have a fear of them being in contact with my body. I was not used to the tropical insects and I always remember being very cautious about things that were flying or crawling next to me or towards me. I was raised in a city with a fairly cold climate, so living without an air condition or an electric fan was quite the discipline for me. The fresh air from the provinces was like therapy for my lungs. Life was simple beyond the city. I cherished the natural beauty of the Philippines. The tropical environment that surrounded me taught me to recognize the importance of preserving God's gift to us, our very dear earth. I have always enjoyed the festivity of the Filipino people. Being around happy people made me happy as well. The positive energy really echoes to others. There was always a reason to celebrate something. For example, in America, nobody claps after the celebration of the Holy Eucharist! However here in the Philippines, everyone claps because they are praising our Lord! I love the breathtaking sensation I get whenever I watch fiesta parades of people in ravishing costumes. I never joined a dance class in my whole entire life until I found out it was part of the college curriculum. I remember participating in the Filipino Folk dance for the P.E subject. In all honesty, I was not coordinated and I easily forgot the steps. There is something quite unique about the gracefulness of Filipino dances. I have come to admire and respect our Filipino ancestors who have set our customs and traditions. With dancing, there is also singing! At every party I went to, there was always some form of karaoke. I would here "Sample, sample, sample!" Next thing I knew, someone was up at the microphone and singing their heart away. In the Philippines, one must sing, dance, or play a game during a celebration. It's impossible that one could get away with it. This is why I will miss the most-ever enjoyed nursing week. The collaboration of the nursing family and the cheerful spirit really inspires me to always relish in the company of others. The positive energy of festivities can really instill an optimistic aura in everyone. As time went on, challenges arose. The hardest and toughest year I faced was my third year. It was the first time I would sleep for an average of 2-3 hours every night. There was so much information to learn. There was also a lot of stress from classmates, friends, family, requirements, and extracurricular activities. I will always remember the time that I talked with my parents through the webcam and my tears just fell. I almost felt like I couldn't succeed anymore. I was discouraged with myself. Just when I felt like giving up, I realized something. For the whole third year, my health was never affected by the stress I was experiencing. Somehow, God was really giving me the strength to enhance my knowledge, skills, and attitude for every day that I woke up. God had been my hope and will forever be my hope. Whenever I failed at something, I perceived it as an opportunity to do better. Nobody comes into the world perfect. For me, it takes 50% faith and 50% personal effort to accomplish a goal. God listened to my prayers and he gave me the talent to surpass the challenges, but it was up to me how I would utilize these talents for the better. The best learning came from both the classroom environment and the related learning experiences. I will surely miss the long lectures and nerve-wrecking quizzes. Most of all, I will miss the related learning experiences. In the beginning, I feared that I would not be able to establish rapport with the clients because of the language barrier. However, after hearing conversations in the dormitory, in the classroom, with friends, classmates, and family, I soon found myself speaking Tagalog! Although I still cannot understand most words, I feel like it was such an accomplishment. I will never forget all the different areas of nursing that I was exposed to. I am so blessed to have had the opportunity to provide my service to the individuals who needed the most. Every rotation led to my own personal growth. I found my fortitude in the blessings and graces of God. He has truly given me the power to surpass the challenges that I came across and will come across. I cannot express how thankful I am to Him for my family, friends, college Dean, clinical instructors, mentors, advisers, and the other people that I came across with everyday. Everyday I encountered a new challenge, but it was the faith that kept me going. Within a span of four years, I was able to come up with my own personal credo that I would like to share with everyone. This is a compilation of my reflections from every year of nursing school and it helped me find more of who I was as a person and as a future nurse. I hope this serves as an inspiration to nursing students. 1st year- Fundamentals of Nursing, the basis of all: This was the foundational year of all nursing skills, knowledge, and attitude. When life becomes a challenge, look at it step by step, and begin with the central importance. 2nd year- Maternal & Child Health Nursing, appreciating life as a beautiful gift from God: Respect the ones who have raised you up meaning parents, siblings, friends, and families. These are the people who have nurtured you to be the best you could be whether or not they taught it in the hardest way or in the most loving way. Appreciate the life that God has given you. Live it to the fullest and be the caring hands of Jesus Christ for others. 3rd year- Medical & Surgical Nursing, the most rigorous yet rewarding year: Accept every challenge as a pavement for growth. Discipline is the best way to deal with the realities of the outside world. Stay positive throughout every hardship and keep faith strong with God. He will never leave your side. 4th year- Leadership & Management, taking the initiative: Be assertive and take on the lead as inspirational role models. Be the positive change for someone else's life. God does not count your success, but he counts the effort you have put to help someone else reach their own happiness and success. Taking up nursing in a different country has truly taught me to appreciate the diversity of culture. Nursing is a rewarding opportunity and a privilege because of the holistic aspect in preserving life, something so precious and unique to everyone. With all of the hard work, dedication, and passion that I have exerted within the past four years, I am proud to say that I graduated Cum Laude. This profession has been a blessing to me and I am looking forward to becoming a licensed nurse ready to care for and save lives!
  3. If you are now at the point in your life when you are one or two of these: you want a career boost, gain better experience, earn more than what you do now, live a tax free-life, encouraged by one or two of your relatives or friends, follow your family in the Middle East (or husband in my case), or simply because it is one of the countries open nowadays where nursing is in demand, you will always deem for a better life for you and your family. As I share my experiences, I will give some tips for you to save time and money as you go through the whole process of getting registered. First Step: Get Your Documents Ready You would not want to end up waiting in vain from winter to summer for your documents to come as what happened to me. To help you in getting your documents ready, here is a list from the Dubai Health Authority or DHA website from the pdf downloaded file: *please read the above carefully You should have your: High School Diploma or Certificate Nursing Diploma or Certificate Nursing Transcript with Related Learning Experience Certificates of Employment or Experience (signed by Human Resource, Nursing, or Medical Director) Nursing Licenses (Valid, from country of graduation and/or last employment) Good Standing Certificates Passport Copy (front and back) Passport Sized Photo (colored, white background) You can visit [THIS LINK] to view online from the website. Scroll down to the Nurses tab then click the link To view licensure requirements and recognized specialty qualifications. If you are from the Philippines, you might want to process this ahead of time before you come here in Dubai especially the documents from PRC. In my case they would not give me Good Standing Certificate because my license is expiring this year 2013 so I renewed my license first before I got to process the certificate which took me another 3 weeks or so waiting for my license to get here for my signature then back to the Philippines to process the certificate. Another thing to discuss is the Attestation, Authentication, Red Ribbon of documents. While it says in the image above (Documents Required image) that "Qualifications Attestation by the UAE embassy and/or Ministry of Foreign Affairs is NOT required.", some of the companies here were looking for it when I tried applying for a nursing job in some Home Nursing companies. It is also required for the application of visa to have your documents authenticated with Red Ribbon then have it attested by the UAE embassy. The documents I have "red-ribboned" were nursing diploma and transcript of records and marriage certificate. Second Step: Scan the documents. Once you completed all the documents, have it scanned in a clear copy Yesterday I submitted all the scanned documents for my application for registration through [DHA WEBSITE] ( Third Step: Create an account then follow the procedures on the video. Before anything else, you must have an individual account in their system. You have to sign up as NEW USER. This video will guide you through the whole process including the submission of all the necessary documents online. Although the applicant is a Dentist, the whole process is just the same. I actually played the video while I am submitting my documents and made sure that I follow the steps. Fourth Step: Pay with a local UAE bank account or credit card On the last page which includes authorization, you need to download the letter then sign it and upload it back with your particulars and the date. Once you reach the payment section, you need to have a local UAE credit card or bank account to be able to pay. In my case I tried to use my Singapore bank account (debit/credit card) to pay thinking it would go through but always prompted me a Failure Transaction Status on my receipt. I called the DHA hotline (800-DHA or 800-342) to confirm and they told me to pay ONLY with the local bank account. Next... Next is to wait for the assessment of all the submitted documents which will take up to 6 weeks. Hopefully, it won't take that long for me because I want to continue my nursing career as soon as possible. I hope this helps you make your own experience in registering as a Nurse here in Dubai easier as for the "First Phase". I am anxious and excited for the exam and since I am always at home, I am trying to look for some review materials to refresh my knowledge about the fundamentals of nursing. Any comments, questions, and suggestions are always welcome ~"Have Faith, Grace Always Abounds"~ a-guide-in-becoming-a-nurse-in-dubai.pdf
  4. allnurses

    Global Nursing Conference and Expo

    What a luxurious way to get your CEUs... The Global Nursing Conference and Expo 2018 conference, organized by EventsOcean, is in an exquisite location offering something special for all who attend. This year it is held in Dubai, United Arab Emirates. The theme this year is, "Combining Multi-Cultural Collective Practices to Bolster Nursing and Healthcare" and is designed for global professionals who are interested in learning new research as it relates to nursing, and how to apply it. Join other nurses from universities, research institutions, and top companies in this scientific podium to meet fellow key decision makers from all over. The Global Nursing Caucus was established in January 2011 in Boston by nurses who had a common passion for global health interests. They saw the need for better communication and partnership in the field of global nursing concerning international health policies, education, and community infrastructure. They teamed up with nurses and midwives at the Global Health Delivery Online and the Global Alliance for Nursing and Midwifery. They hope to impact on a global scale to improve healthcare for all through advocacy, research, practice, and policy. Conference Date and Time Thursday, September 13, 2018 - 9:30 A.M. through Friday, September 14, 2018, 6:00 P.M. Gulf Standard Time United Arab Emirates Time. Conference Location JW Marriott Hotel Abu Baker Al Siddique Road, Deira Dubai, United Arab Emirates (UAE). PO Box 1659. Keynote Speaker Kim Knight, the Kiwi Health Detective Topic Treating the Patient, Not the Illness Sessions Brochures are available for download. Nursing Research and Education Women's Healthcare Nursing Clinical Nursing Holistic Nursing Geriatric Nursing Pediatric Nursing Cancer and Perioperative Nursing Psychiatry and Mental Health Practices Travel Nurse Risk Factors, Patient Safety and Palliative Care Community and Family Nursing Practices Ethics and Laws of Caring Nursing Practices and Management Advance in Nursing and Technology Registration Use Coupon Code EARLYBIRD (without spaces)TO AVAIL 50% Discount on all passes. Refunds are available if requested 30 days before event. Student Pass $300 Delegate Pass $499 Speaker Pass $59 Registration Includes Conference kits Handbook Certificate Access to all Sessions Lunch Coffee Poster presentation if you elect to Poster Abstracts Early bird registrars will receive 50% off the price All debit/credit cards will be processed through PayPal, you can also pay at the event For hotel and travel information, use the registration link for the best information. Contact Information Dilwar Hussain Mazumder Complex Old Lakhipur Rd Silchar, Cachar Assam - 788001 India Email and Telephone Nursingcongress@eventsocean.com Nursing@eventsocean.com +91-905-233-8000 +91-912-177-2846 What to Do in Dubai Plan your visit to Dubai and allow plenty of time to explore the futuristic city that looks out over the Arabian desert. With over 3 million residents, it is the largest city in the UAE and the capital of the Emirates of Dubai. If architecture interests you, make sure to see the Burj Khalifa the 828.8m skyscraper that is the tallest structure in the world. If shopping is your thing, shop your heart out at the Dubai Mall. It's part of a 20 billion dollar downtown complex and boasts 1200 shops. The largest mall in the world is sure to satisfy the largest therapeutic shopping craving. For the nature lovers, enjoy the Dubai Creek that runs through the Ras Al Khor Wildlife Sanctuary all the way to the Persian Gulf. Things are built big in Dubai, like the largest choreographed fountain on a 30-acre lake at the center of the downtown development. There are museums, restaurants, and tours available to satisfy any traveler's desires. Make sure that you bring your best friend or family with you to enjoy this spectacular place.
  5. jtweedie

    The Cultures of Nursing

    The job duties, the vocabulary and the hospital were a far reach from anything I had experienced as a nursing student in San Francisco. The ward of the hospital I was assigned to used to be a debtor's prison. This was culture shock. I was used to private and semi-private rooms. I felt like I was experiencing nursing history firsthand. Patients were in "Nightingale wards" with twenty to a room with each bed divided only by curtains. The walls of brick did not contain the modern conveniences I was used to. Oxygen was brought in huge green canisters and placed by the patient's bedside when ordered. The canisters were extremely heavy and only the orderlies were expected to move them. Medications had different names than in the United States, although sometimes the generic names were more familiar to me. Paracetemol was used instead of Tylenol and peppermint water was given for indigestion. And instead of sedatives for bedtime, some patients were prescribed a bit of sherry in the evening. The newest task I had to learn was to serve afternoon tea. I learned to brew the tea the proper way and then arranged the teapot and tea cups and saucers to be taken to each patient's bedside. One afternoon a patient asked me when tea would be served. I replied, "I'll go and get the cart with the tea." The whole ward of patients laughed out loud. "A cart, you're going to bring the tea on a cart? That's what a horse pulls. You mean a trolley." I learned that lollies were candy, and jumpers were pullover sweaters. I called head nurses "Sister". The hardest part was deciphering the different Scottish dialects. In the close quarters it was easy for some patients to translate for me. The word I heard spoken most often was "ken". "I no ken" and "You ken?" New to me, I finally figured out that it meant "know" or "understand". The whole experience, even the way I dressed and got dressed was different than what I had learned in nursing school. I had to go to the nurse's dormitory each morning to change into my starched white uniform and cap to walk to the hospital. One morning I returned to a ward to see how a patient was responding to a medication he had been given. There was no response at all. There was no pulse, no respirations. Another nurse and I began CPR. As a student nurse, I'd learned but never used my CPR skills. This time it was for real. The code was called, the physicians and other nurses came, and the orderly with the huge green canister of oxygen arrived. Eventually the patient was resuscitated. Most importantly I discovered that not everything I learned was different. Some things were merely part of the worldwide culture of nursing.
  6. I am a RN working that time on a neurological unit for rehabilitation in a foreign country. Patients have been transmitted from hospitals frequently. Many of them came from countries all over the world to receive treatment; a lot of them called it their last hope. Patients of all ages, complex diagnosis and often depressed about their situation. After receiving the shift report this morning I started my morning rounds. One of my patients, Mr. P. 65 years old, hemi paresis and aphasia after having a stroke, sitting in a wheelchair. A tall and slim man, one of the patients I will never forget! This day he should be transferred back to our unit. He was placed to the hospital for the last two days because of his suicidal intent. Since that day he was admitted from the hospital he often refused therapies he was scheduled for. Every assisting in ADL's seemed a torture for him. He rarely answered questions by using his hands and mimic. Weeks went by and nothing in his condition changed. By the time other patients learned to walk and speak again his progress remained the same. His wife was always worried about him, she visited him nearly daily for several hours. Pictures from their holidays and one of their marriage were placed on the night table in his room. While taking care of other patients that shift, Mr. P.'s wife appeared on the unit. She spend time waiting for me, I remember never seen her pale and silent before so I went over and asked her how she felt. That moment she took me next to her and offered me a family tragedy. After receiving several treatments against brain cancer, they finally saw their own daughter dying in hospital at the age of thirty years. The only child they ever had. She and her husband could never accept what happened; it was the deepest impact and took still part of their lives. She looked overwhelmed; tears were running from her eyes. "He is afraid of ending up the same way his only daughter did." She said. I felt frozen for a moment. My eyes were fixed on her lips, catching every single word she spoke. "The only way he sees for himself is to attempt suicide." I sat down with her. "It worries me that he will never reach his rehabilitation goals". During the following days and weeks I talked a lot to him, hoping to change his mind. I told Mr. P daily what a wonderful wife he had. The only family member who was with him and ready to go through everything what would come cross their way. That every ones time on earth had his own frame but that he was still here. And whatever brought you down lets you get up stronger. He sometimes smiled at me. While starting another morning shift, the nursing assistant was running back to me, telling me that Mr. P. was not in his bed and could not have been found on the unit. No one else had seen him this morning! I went to the room to convince myself. The bed was empty.... The bathroom... nothing! BUT the wheelchair was missed! Attempting to call the physician and the police I grabbed the phone. Before my fingers could dial a number, an incoming call reached me. It was Mr. P.'s wife. She told me that her husband would be in front of her gate, sitting in his wheelchair. She sounded upset and happy the same time. My heart dropped down. "Today is my Birthday, my husband wished to attempt."She said. From that day Mr. P.'s resources improved and he was finally discharged to a concept of assistant living. All our team members were still motivated to reorganize our patients ADL's and assist them and find a solution to help them to move forward and reach their goals. There is only one thing no one can give you.... It's your own motivation!
  7. A magnitude 7.0M earthquake1 rocked Haiti in January of 2010, when our daughter Riley was only a few months old. A 7.0 is big. By January 24, 52 aftershocks measuring 4.5 or greater were recorded. Haiti is a country with high national debt, poor housing conditions and a high level of poverty, so the death toll was high; somewhere between 100,000 and 316,000 people died. Conditions and politics in Haiti made it difficult to settle on a final number of fatalities. When the earthquake hit Haiti, I had been a nurse almost 4 years. During that time I had worked in oncology, cancer research, and integrative health, and I was getting my MSN, but I never lost sight of my original reason for entering the field of nursing. I wanted to get my hands dirty, helping people. As my husband and I watched the news and saw the horrifying effects of the earthquake, I thought to myself, I have to go there - this is why I became a nurse. I asked around about medical mission work in Haiti and discovered a local group called Mission Manna (which later became Consider Haiti2). One of the reasons I wanted to go with a local group was because I had heard so many bad things about large national groups. News reports3 suggested that many of our donation dollars were not getting into the hands of those who needed it the most. Mismanagement of funds and politics often get in the way of good intentions, and I wanted to do the most good with the small resources I had to offer. Consider Haiti (CH) utilizes 95% of all donations in Haiti. The group directly funds local, Haitian workers to lead relief efforts. CH has worked for 15 years to empower a small group of communities to be self-sustaining, running programs in Montrouis, Fon Baptist and Ivoire, including community health; sustainable nutrition, clean water and medical care programs. Consider Haiti runs two, weeklong medical clinics for Haitian children each year. One trip goes in the fall and one in the spring. More than a thousand children are seen during each trip, and the pediatric clinics are often the only healthcare the children receive each year. Services include food, nutritional supplements, growth checks (height & weight as well as head and arm circumference measurements), deworming, vitamins and education. All volunteers pay their own way, so I started a website/fundraiser to pay for my plane ticket, and requested the time off of work. Preparation for the trip involved visiting the local community health department for immunizations4. I got a Typhoid immunization, and updated my Tdap. The risk for contracting Malaria in Haiti is moderate. Malaria prevention consists of a combination of mosquito avoidance and chemoprophylaxis. I purchased some insect repellent with lots of DEET, and decided to do the Atovaquonone-proguanil5 chemoprophylaxis. You start taking this drug 1-2 days before travel, take it daily at the same time each day and daily for 7 days after leaving the area. It is well tolerated, and side effects are rare. I also got a prescription for Cipro to take with me in case I accidentally drank contaminated water and got traveler's diarrhea. We met a few times before our departure date. Many individuals and healthcare companies donated medicines and medical supplies, and we had to go through all the supplies and do an inventory. We took expired medications (I can write a whole article on that since studies have shown meds don't actually expire6). The main medications we took were skin related - every topical ointment you can possibly imagine from triple antibiotic ointment, to Vaseline to hydrocortisone, to Tinactin. We also took huge bottles of Ivermectin for deworming. Hypertensives and antibiotics were also in high demand. We had dandruff shampoo and moisturizer as well. We also had to bring scales for weighing, wound care supplies, basic pediatric rehydration supplies (IV kits, tubing, bags of fluid), oral rehydration, and empty pill bottles and ziplock bags for handing out prescriptions. Gloves, wipes, alcohol prep pads, a few injectables all had to go. I got a book of Haitian medical phrases and started practicing. I heard over and over again to not bring candy or toys for the children - "it's fun, but you will run out", and to instead bring deflated soccer balls and an air pump, and lots of American dollars. Infusing the economy of Haiti with our money by purchasing goods and services is the best gift we can give. I packed a lot of small bills in preparation for the arts and craft sales I was told would go on daily outside our compound. We'd be staying at a resort - kind of embarrassing, but the only place at the time that was safe for white people to stay in the area. I packed modest t-shirts and shorts, as well as a few skorts, being warned to not wear revealing or tight clothing. I also brought my computer so I could write – we were told there was internet at the resort. My plan was to post on Facebook daily for my family and financial supporters. Essential items included a sleeping bag and pad, a headlamp, a box of gloves, a hat, sunscreen, water bottle and good walking shoes. Not much else was needed. I also brought my running shoes. The founder of Consider Haiti was going with us and she assured me that we could go for a run, if I didn't mind being stared at like I was insane. I have never minded, and it happens all the time here, so why would it be any different in another country? We were all told to bring an extra, empty suitcase to take meds and supplies. We were also told not to declare anything, and to not make a big deal out of being a medical mission. There was always the possibility that everything we were bringing would be confiscated at the airport, though with bribes to the right people, we should sale through customs. The group consisted of 12 people: 3 doctors, 2 Nurse practitioners, 2 people who were not in healthcare, the founder of consider Haiti (who is married to a Haitian and speaks perfect Creole), and 4 nurses. I was rooming with another nurse who had never been, but almost everyone else had been on multiple trips. I was interested to see what the country looked like from the air and was sad to see the deforestation I had read about confirmed from above. As we landed I could see the airport itself had suffered in the earthquake - I saw pile after pile of rubble, where buildings had once stood, and so many people missing limbs from the crushing injuries so common in a quake. I didn't see a single building over 3 stories tall, with most being one story. There was row after row of homes thrown together from aluminum siding, concrete, boards and tarps. The water source ran in a ditch by the road. The air was thick and full of smoke, graffiti was everywhere, the roads and streets were choked with motos, buses, tap taps, bicycles, horses, donkeys, dogs, people, pigs, goats, chickens and trash. People were everywhere, carrying baskets on their heads, dancing, talking, trading, fixing things. Food vendors sold unidentifiable meats, fruits, grains, candy, soda pop. It was overwhelming. Even though we were at a resort, we were instructed to NOT DRINK THE WATER, including ICE. Many people do well with this until they get in the shower. We are so used to opening our mouths in the shower, but a good trick I used was to wet my toothbrush with bottle water, and brush before getting in the shower - holding the toothpaste in my mouth while showering ensured I didn't take too long of a shower and didn't open my mouth in there either! Guards with machine guns stood at the entrance (a necessary precaution I was told). We were told it was fine to leave, but best to go in groups. The guards were to keep people out, not vice versa. The first day hundreds of families were already waiting for us. We set up a few tables, and had our Doctors and NPs sit at tables with translators. The first day I worked at the deworming station. We crushed mixed the Ivermectin with a pudding called la bouie, which was made by the host community. The dose was scooped into a small plastic cup and each child was brought to us. We exhorted each child to mange, mange la bouie (eat, eat the pudding!). They would look up at us with wide eyes and open their little mouths for a bite of pudding. Other stations included weights and measures (each child had a card to show growth from the previous visit), followed by a visit to the doctor's table, prescriptions and treatment if needed and nutritional supplements if the family was in that particular program. We saw several "Kwash" babies - children with protein malnourishment called Kwashiorker7. In these children, the visible manifestations included orange hair and skin, and swollen bellies. I overheard the nurses commenting that there were fewer "Kwash" babies this year than last year. Subsequent days found me doing weights and measures, working the prescription table, and handing out supplements. I was interested to learn the most common maladies included high blood pressures, high blood sugar, malnourishment, and "female" problems. So many women came to us with venereal disease or UTIs due to the lack of education about prevention, and no access to condoms or running water. Here is a quote from one of my journal entries to sum up the experience: An older woman came in today with a 19-month-old child (Riley's age) the little girl was very quiet and thin. For some reason M__ asked this woman what her story was - after the earthquake, her house burned down and she lost her family - she was wandering around when she heard a baby crying. This little girl was lying in the grass with a huge, infected abscess on her leg. Her parents had abandoned her because they thought she would not live. This woman took her in and nursed her back to health. They have nothing; nowhere to live, and nothing to eat. The woman said she took the little girl in because that is what Jesus would do. At this point we were all sobbing. I am crying now. We all snuck money into the woman's purse and told her she was a good mama. She said she and the little girl love each other, and that is all that matters. I want to encourage anyone reading this to go on a medical mission trip. At a minimum, please consider getting involved. At the end of the day it's purely selfish – you end up feeling good about yourself, and about the work you are doing- it changes you. You become a better person. The help one American dollar can give in a country like Haiti is astounding. I am sending a lovely young Hatian woman to nursing school, and you can read all about that in part 3. References 121 Haiti earthquake - Wikipedia 2 Consider Haiti 3 Investigation Of American Red Cross Finances Finds 'Fundamental Concerns' : NPR 4 Health Information for Travelers to Haiti - Traveler view | Travelers' Health | CDC 5 Malaria - Chapter 3 - 218 Yellow Book | Travelers' Health | CDC 6 Drug Expiration Dates - Do They Mean Anything? - Harvard Health 7 Kwashiorkor - Wikipedia
  8. BonnieSc

    Third World Code Blue

    Anatomy of a Code I just left a code blue, a very successful one. Yes, the patient died; he never had a rhythm. But a list of the learning experiences we had this morning would cover two pages. At the beginning of the debrief, I thanked the patient for giving us this gift. Where I work.... I work in a developing country in East Africa (not naming the country for anonymity's sake). But I don't work in a refugee camp or a primitive cinderblock hospital like those I used to see in the news; I work at one of the better-equipped hospitals in the region. When I first arrived a year ago, I doubted whether I was really needed, whether I shouldn't be somewhere where the need is more desperate. But not only has this hospital demonstrated some real gaps that I have tried to help with (it might be the best, but it is very far from a western hospital), but we are a beacon for the rest of the country, a small microcosm showing what might be accomplished with more staff, more supplies, more water and electricity. Cardiac Arrest The code blue, or "resuscitation", as we call it here, started the same way they do in the US: a patient's relative came out and said the patient wasn't breathing. I found out about it the same way I do at home: someone called for the crash cart (or "emergency trolley"). I left my office and went to see what was happening. I saw someone giving chest compressions without gloves on, so I put on gloves and took over. Getting Started There's no overhead paging system. Someone ran to the ICU and the nurse manager and charge nurse came over to be the code blue team. Doctors got wind of the situation and came in. The nursing students came in the room but hung back. My nursing students this week are experienced nurses with high school educations, in the process of continuing their educations to get a nursing diploma through a bridge program. Certainly they had seen many patients die, and perhaps had even attempted resuscitation, but they never had seen a coordinated effort with this kind of equipment. Teamwork What went well? Teamwork. The nurses looked for unmet needs and moved quickly. When I participated in a resuscitation earlier in the year, it was chaos; some things happening, other things not. Mostly, I have been frustrated by how slowly the staff often moves in cases that seem urgent to me. Later someone might explain to me that no one moved fast because they considered it a lost cause. The nurse manager and I have been trying to change that way of thinking. Compressions also went pretty well. It has been hard to train people in CPR without enough dummies; often for our CPR classes (taught by a local nurse; I'm just there to help with a practice station) we have three dummies for thirty people. But I saw that with some coaching, the staff is now pushing hard and fast. We just have to work on placement. There is a perception that compressions should be done over the heart instead of on the sternum. When you do CPR in a different language, there are some surprises. The language of the hospital is English, but most staff are more comfortable in French, and most comfortable of all in the local language. Counting to thirty in the local language takes way too long--the number words are lengthy. Some count in French, but they are "supposed" to count in English (I couldn't care less, but that's how they're taught). Except remembering how to count to thirty in English is hard for them even when they aren't under stress; forget doing it in the middle of compressions, loudly. Typically, they count to ten three times in English, speaking under their breaths. Try being ready to give breaths in that situation! Struggles So, what were the struggles? One, and I include myself in this... those directing the action were trying to do too much. No one can do good CPR or give effective respirations if they're also trying to tell others what to do. I took myself and the ICU manager out of the patient's direct care, stopped a nurse from doing anything besides giving medications, and told the resident leading the code that he was not to be in line for CPR. I was the most experienced at BLS/ACLS, the ICU manager knows more about the contents of the crash cart and can speak the language if necessary, and the doctor needed to be free to make orders. I am used to working with an extremely efficient code blue team where everyone knows what to do and where to stand. I remember how unnecessarily perfectionist some of that seemed when we started the code blue team. The value has never been clearer. We didn't start ACLS soon enough. Epinephrine was given somewhat regularly, but otherwise, we were really doing BLS. We started with an AED and didn't switch completely to the manual defibrillator. I have probed before about why, when outcomes are just as good if not better with the AED, we still use the manual defibrillator in the US. OK, I get it now. I didn't realize how much I relied on being able to read the rhythm on the manual defibrillator. ACLS You know that ACLS algorithm that hangs off every crash cart at home? Usually I don't see anyone consult it, but we really could have used it and I definitely see its value. I asked the ICU nurse manager about the algorithm later; she told me it is posted on the bulletin board in every nurses station and then agreed that it would be better stored on the crash cart. Intubation We disagreed about intubation. I asked (in the middle of doing compressions, oops) if anesthesia was coming to intubate. I was promptly told "the priority is compressions". This is a problem I run into a lot here... the nurses and doctors receive half the message but the whole story is lost. Yes, the compressions are the priority and I'm glad they understood that, but it doesn't mean intubation is just a "nice to have". I think part of what played into that--once intubation was attempted, twenty minutes later--is that it was clear the doctors aren't very comfortable with intubation. Anesthesia wasn't available, so a medical resident tried, with some difficulty (we never made it). There were great delays in compressions while intubation was attempted. This is one of those things that the ICU nurse manager probably understood but didn't say; I was the only one who didn't know. Supplies Supplies in the crash cart were severely lacking. We didn't have enough of any of the drugs; we had few options for suction tubing. The CPR board was attached to the crash cart with zip ties and we lost valuable time waiting to get it placed (no CPR button on the bed, of course). And when the first dose of epinephrine was given and I asked for a saline flush, I remembered immediately that we don't have that. I asked for a nurse to start drawing up flushes, and what was available was sterile water rather than normal saline. The nurse drawing up medications understood my point and began drawing up water flushes every time he drew up epinephrine, but another nurse might not have. And several people told me it was unnecessary because the patient had a running IV. Because flushing isn't common practice in any case, there isn't a great understanding of how fast a flush moves versus an open IV. Outcome The doctor called the patient after half an hour of resuscitation. If we had known how ill he was (metastatic cancer, which wasn't what he'd been admitted for), we might have stopped sooner, but we never had a chance to talk about that. When the doctor said "Okay, we are stopping," I said promptly a variation of the words I know so well: "Does everyone agree that we are ready to stop this resuscitation? Does anyone want to try anything different?" Everyone looked at me in surprise. I made quick eye contact with all of them. "We've done everything," the ICU nurse manager said, puzzled. "I know, but this is the question we ask," I said. Everyone agreed to stop. I thanked everyone and, because this is a religious country and we pray together before starting shift report every day, I asked one of the nurses to pray for us and the patient before we cleaned up. This, too, isn't the practice and was a surprise to everyone, and yet it seemed like the culturally appropriate thing to do. I wondered if in trying to make resuscitations as streamlined and western-like as possible, the staff had come to feel like their own cultural practices were not welcome or appropriate. Conclusion The resuscitation itself was a straightforward one. Nothing unusual happened; nothing we did for the patient did any good. But it was yet another situation in which I learned and grew at least as much from being here as the patients and staff benefit from my presence as a nurse educator.
  9. "New age" describes a recent trend in the United States toward alternative solutions to those provided by science and modern medicine. This new sense of spiritualism embraces some old solutions like the mind-body connection, massage therapy, natural methods and medicines, homeopathy, yoga, candle therapy, acupuncture, and other things excluded from a typical visit to a physician's office. This new trend in the U.S. is not so new to immigrants from Latin America. What we call "traditional" or "folk" medicine has been practiced in their home countries for a long time. These practices have coexisted with modern medicine. Practitioners of traditional remedies do not consider the traditional and modern solutions to be distinct, but rather complementary. So we should not be surprised that some Hispanic patients may have sought natural solutions before visiting a physician's office for healing. Some patients believe strongly in curanderos or spiritual healers. Some have brought with them a system of cures passed down from generation to generation for self treatment. Supplements and special diets are popular in Latin America. Often a visit to the homeopathy shop, or even a farmer's market, provides natural medicines for certain ailments. More surprising for many U.S. healthcare providers is the belief in a direct relationship between wellness and magic. Consider the following examples of folk maladies recognizable to many Latin Americans. Digestive Distress Empacho is a type of indigestion identified with symptoms such as stomach pain, swelling, fever, vomiting, acid reflux, diarrhea, and lack of appetite. These are symptoms associated with ulcers. The condition is often described as a ball of undigested food stuck to the stomach wall. Some believe it's caused by an excess consumption of certain rich or greasy foods. Others say it results from forcing someone to eat something against their will. Psychic Distress Susto (or "fright") is an emotional illness affecting anyone at any age. Symptoms include depression, nausea, anorexia or weight loss, insomnia, hyperventilation, and nervous breakdowns. It is traced to supernatural causes. Each person has a body and a soul. If a person suffers a traumatic event, his or her soul may flee the body. The soul must be returned to the body, through magical means, or the patient's life is at risk. This condition could mask a general infestation or meningitis. Caregivers working with pediatric patients should be especially aware of this phenomenon. Mal aire ("bad air") is a psychic form of possession resulting in respiratory problems, muscle aches, and nervous or digestive problems. It is believed that people can be taken over by deities borne by the wind or by the spirits of victims of a violent death. Since the cause is spiritual, so is the cure-rituals performed by a healer-, sometimes in combination with healing herbs like the common rue plant (ruda), sage (salvia) or rosemary (romero). Infants Fallen fontanelle (mollera caída) affects new born babies. Babies are born with delicate craniums which do not firm up until 7 to 19 months of age. When a baby suffers from dehydration from excessive crying, diarrhea or fever from a bacterial infection, the upper front of the cranium may sink in. In these cases, a healer might push up on the upper palate of the baby, or hang the infant upside down. Infants are the most common victims of "evil eye" (mal de ojo) and other types of mal puesto, or hexes. This type of magic spell is performed after securing a personal object belonging to the victim such as a lock of hair or saliva. All that's required is a simple look from a powerful individual, often motivated by envy. The solution is also magical, of course. It is the caregiver's role to find a medical solution to the excessive crying, fever and other symptoms presented by infants, or time spent seeking a magical cure may allow an undiagnosed illness compromise a baby's health. A Better Cure: Culturally Competent Interviews Healthcare providers managing care for Latino immigrant patients need to be aware of the prevalence of alternative practices common in Latin America. Often these practices are not even on the radar screen of U.S. physicians and care givers. But imagine the health risks related to negative interactions between natural and pharmaceutical remedies. Natural remedies and supplements could interact with prescribed medications. And also consider the fact that patients may self treat or rely on the advice of a spiritual healer and thus delay a trip to a clinic or physician's office when haste is essential to effect a treatment or cure. The solution is not to contradict or ridicule a practitioner of alternative therapies, but to work within the cultural framework of the patient. The first task is to find out if a patient is following a form of traditional or folk medicine. Review the following culturally-sensitive questions inspired by the work of Dr. Arthur Kleinman of Harvard. (Refer also to the writings of Dr Nancy Neff of the Baylor College of Medicine, and Berlin and Fowkes' LEARN method.) Underneath each question set is an explanation for the purpose behind the questions. What do you think is the cause of your condition? What do you call this illness? How do you believe the problem started? How often does a healthcare provider ask the patient what the patient thinks is wrong with them? Surely some chatty patients will share their own theories with their doctors and nurses, but doesn't the modern provider filter out this "noise" when assessing a patient's condition? Asking these questions may identify what the patient believes is the source of the problem. With this knowledge, the provider can assess the situation and work to separate the affective or emotional side from the physical ailments. Don't discount the patient's beliefs but rather dig deeper to isolate physical symptoms. What remedies are you taking to cure the problem? Have you consulted anyone? Whom? A doctor? A spiritual healer? What did he or she advise? Did someone at home treat you? What did they give you? Are you taking any supplements? These questions are intended to reveal to the healthcare provider whether the patient is following any alternative practices or taking any natural remedies or supplements. Home remedies could be dangerous when combined with pharmaceutical drugs, or they may be benign. If the remedies have no effect on a health outcome, we advise against discouraging the patients from taking them. Respect their familiar practices and beliefs. Since spiritual healers can include Catholic priests, we advise using this term instead of curandero in order not to insult a "modern-thinking" Hispanic patient. What are you afraid will happen to you from this illness? What treatment do you believe you should follow? What results are you seeking? The answers to these questions will help the healthcare provider assess whether there will be any interference between modern and traditional cures. It also provides an opportunity to anticipate what will happen to patients as they follow recommended treatments, and to discuss realistic expectations for a cure. Including any harmless practices the patient is engaged in-like drinking an herbal tea or wearing a protective amulet-is a good idea for two reasons: it shows you respect their beliefs and it may result in a positive placebo effect. Saying there is 'nothing to fear' or that 'the best thing to do for now is nothing' is not enough. Be aware that Latin American patients who leave a physician's office without a plan of action that includes medicine or supplements may not return! The percentage of Latin American folk medicine practitioners is relatively low when compared to the huge number Hispanic patients managed by the U.S. healthcare system. But these precautions can help assimilate the recent immigrant and their families into good health and improve wellness outcomes for all patients.
  10. I have worked first in Dubai as RN also,I took DHA exam and passed. The eligibility letter was handed to my Employer Dubai based and made it to license. After two years I was offered in other hospital in Sharjah. In Sharjah,we need MOH License. So I needed to convert my DHA to MOH. Then after a year I moved to ABu Dhabi. They said our RN Licenses are our investment. That is a fact because we always have to give our time and financial resource to have this license to practice. Let it be if its costly just find a way on how to make means of getting that RN badge. In due time we will harvest the wisdom and passion of Nursing. If you think that 4 years in BSN course has ended and youre misery is done then youre wrong. Nursing is indemand,nowadays UK,Australia,Ireland,NZ,Japan are facing millions of shortage by 2020. In these countries you need to pass their requirements like the ielts and licensing. And there you go you need to invest to earn that Badge of RN to practice. Review,take exam,voila your license is out! I'm foreign nurse here in UAE and got lots of paper work to do if you want to be a nurse in different emirates. I just want to share my experience in my Haad license So if you're reading this means you are confused on how to convert your RN license to other emirates' health Authority. Firstly, you need to get Good standing certificate from your Health Authority. Hope you still remember your username and password. You may apply thru online. It will cost you estimately 150aed. You need to state the purpose of this.Then wait for 2 to 4 days they will email it to you. In this time,You may ask your HR also for COE. You have to maximize your time as converting your DHA/MOH is taking long time. Secondly, create an account for your dataflow. This agency is the verifying company of health authorities here. Theyre like the cgfns for taking nclex they will verify your credentials if you are really working as Nurse before like that. And also the school credentials authenticity. You need to fill the authorization letter that you are giving them the consent to do this. Provide all the documents especially the POLICE CLearance which may take 1 week. Fill all the information. I had my dataflow from DHA,MOH,so i Just attached all my reports there. The waiting time for this is 3 to 6 mos. I have paid 1400 approximately. I always contact the dataflow regarding my conversion of MOH to HAAD license. I was very exhausted. And also I forgot,they will send you a form that you havent sit for HAAD before like that. Thirdly, HAAD will notify you for your username and password. Login, fill the information, and submit it. HAAD will reply for any alerts or missing documents. if theres a problem you may contact: Abu Dhabi Government Contact Centre or this: Please communicate with dataflow to confirm that the application is pushed to HAAD, dataflow email haadsupport@dataflowgroup.com or attend to HAAD customer service counter 15 or 16 or call the Dataflow office on +971 4 365 4477 You may ask help from your new facility because theyve guided me in this stage. I was notified that my license HAAD RN is for delivery in empost. THANKS GOD! If any questions, please feel free
  11. There are many reasons why international nursing experiences are important. Some reasons include global understanding, increased knowledge, increased self-confidence, and increased cultural competence. As a student, these experiences can help guide a career. This is the story of one person's experience and how it affected a thirty-some year nursing career. As a senior nursing student, I went to an Asian country with a group of women who wanted to provide healthcare to refugees. There was a doctor, translator, myself, and others. The experience was good but hard. Seeing the devastating poverty and the difficulty that the people were in, was difficult. The clinic we used was a very small, one room building with a screen, a mattress, table, chair, and a bench. I conducted health assessments and assisted the physician with procedures and other activities. One day at the clinic, a woman brought her child who was severely malnourished just skin and bones with a large head. When the physician saw the baby, she knew that there was not much that could be done. I wanted to do so many things to help the child. Finally after discussing with the physician, we decided to investigate what was happening in the home. There was a young girl about 12 years old who could speak English well enough that I could ask to translate for me. I went to the home and brought some formula that I could teach the family how to make. The mother had very little milk production and the child had very little ability or want to suck. We boiled water and measured it and the formula. I then showed her how to feed the baby with the spoon, after the milk was cooled. She was reluctant so I did it. I encouraged her to continue to breastfeed as much as she could. I came back every day to help the mother through this difficult time. It was hard to feed the baby, he did not want to take anything but eventually, he was able to take the milk after several days of getting small amounts into his frail body. The mother easily learned how to make the milk but the feeding took time. After several days she started using the spoon to feed the child and he would take it, and each day he would take more and more. By the time that we left the country, the child was taking about 45 mL of the formula. However, she was getting more milk and the baby started sucking a little better. When we left the camp for the last time, I cried. I did not want to leave, I wanted the child to continue to grow. I continued to pray for the child. During the trip, there were so many other opportunities and experiences. This child was a big part of my first experience. When I returned to the U.S. I used the experience for a senior seminar and had to write about the experience. I chose to write about this child and to write a care plan for the baby. I could have written every single nursing diagnosis known in nursing, however, stopped at ten. I learned so much through the experience. Two years later, on a second experience as a nurse, I was able to see the child, he was a frail little boy standing against his father's leg eating a small piece of bread. A flood of joy and thankfulness came over me, that the child lived. This experience and many others followed me throughout my nursing career. I worked in an African country for several years, had many different malnourished children who came for help and each one was very special. Now, I teach nursing and share my experiences with students. I take nursing students on transcultural experiences yearly. The experiences help students to see another part of the world, poverty, and how culture affects healthcare. Most students go through cultural shock; however, are able to come through it because they are allowed to express their frustrations, are listened to, and have the opportunity to debrief on a daily basis. I have seen students mature during the experience. My joy comes when they get through the cultural shock and are able to increase their cultural competence. International experiences as a nurse helps to increase nursing opportunities and increase understanding. If you have ever had the opportunity to go on an experience you can understand that it does provide a great experience. If you ever have the opportunity to go on a trip, go, it will make a difference in your life and career.
  12. Pinaynursemeetsworld

    Caring for nurses in a multicultural environment

    Caring for a patient must be no limitation and no boundaries. It should be given freely, compassionately under the standards of nursing care practice. But somehow, it is not being given in a way that it should because of uncontrollable factors that exist within the nurse and the patient environment that makes it hard for the nurse to reach out to her/his client. The best example for this is when the nurse from one culture handles a patient from another culture with different religion, beliefs and language. The nurse will have encounter difficulty in understanding his/her patient because of their differences. In this article, the research study took place in Saudi Arabia. A close and conservative country where the majority of their population recognizes Islam as their one and only religion. Saudi Arabia patterned their political, family, economic, social life according to the teachings of Quran. They have certain beliefs and practices that are different from other culture. They believe that men and women should not be mixed and socialize with each other because its Haram. They also believe that eating pork or any foods cooked in a pork oil must be avoided because it destroys a person's cleanliness. Arranged marriages are being practiced by every family. They can marry their first cousins and men can marry four women all at the same time as long as they have the financial capacity to support each of them. They also believed that women should wear abaya and cover their face because to stay pure in front of their husband or future husband. They also don't practice organ donation, funeral, and baptism. Their main language is Arabic and majority of them are not good English speakers, readers, and writers. To work in Saudi Arabia as a nurse requires a person to be strong in many different aspects of life. Aside from the fact that you are working away from your family, you will also encounter difficulties in dealing with your patients, co-workers, and patient relatives. Saudis don't trust their caregivers too easily. One way of gaining their trust is to first learn how to speak and understand their language. Foreign nurses are expected to speak and understand the basic of Arabic language in order to communicate well with their clients. It is not easy, but it is not impossible to learn it if you are dedicated to rendering quality care. Aside from learning their language, a nurse must also be knowledgeable about their common everyday practices like praying 5 times in a day, assigning same- sex caregiver to the patient and all other basic and simple practices in order to gain their trust and build a rapport. Nurses must also be aware of their own culture and have a broad mind to accept that there will be times when a patient's demands and ways are unacceptable on your own culture. Nurses must possess limitless patience and understanding in dealing with Saudi clients because you will experience them yelling at you, writing a complaint against you and telling lies. Some patients will also ask your to do things that are not under the scope of your practice like fixing their air conditioners, faucets, switching the channel of the television and even opening or closing the lights in their room. It may sound degrading in our culture but for them, it is a part of the nurses job because it's also caring for them. The meaning of caring differs from person to person. Its meaning depends on a person's cultural background and life experiences. A nurse must learn how to understand and adjust with their patient at all times because it is our duty and responsibility to be the patient's helping hand and advocate regardless of their race, age, and status in life. We also sometimes need to disregard our own belief and pride because it could affect our nursing decision and judgment towards understanding our patient. If we learn the right approach and strategies we will be able to give the best quality nursing care and save lives.
  13. interleukin

    Love and Healthcare in the Third World

    It almost appears that parents in the African bush don't seem to care when flies crawl over their child's face, or when their children play in contaminated water or sleep in flea-infested dirt-floor huts or catch diseases long eradicated here in the "developed" world. But too often these images are aired to advance specific agendas. So, I wanted to check out at least some small part for myself, up close, not filtered through someone else's lens. I always thought the more I experience the landscape of human condition, the better I will be at nursing. Nearing the end of five months on a journey across Equatorial Africa, I found myself with two nurses dispensing vaccines outside the village Jinka, Ethiopia. I rode with them through a parched landscape. The riverbeds were bone dry and the sun unremitting. We visited adobe-type huts filled with families. Children played and laughed. Babies were swaddled in colorful cotton, wrapped tightly against their mothers' backs. It is said that the feet of an Ethiopian child never touches the ground for the first year. Here, in the USA, we worry about VAP rates, and we should. There, they struggle to maintain the integrity of vaccines without reliable refrigeration. Here, we worry about childhood obesity, and we should. There, they worry about malnutrition and dysentery. These nurses were like primary care physicians. But there are so few of them. The pay is desperately low and the supply chain for medicine fragmented. Much care is provided by foreign organizations. We discussed the need for education in these rural areas. But in a country of more than 77 million people, there are only seven schools that offer a Bachelors of Science in Nursing. This results in a nurse-to-person ratio of about one per 4,900. Obviously, misery exists and the challenges are daunting. But, here, in this collection of huts, I saw love in the eyes of the mothers and the of play joy in children. Outside one hut, I heard the rhythmic grinding of stones. Through the portico entrance, I saw a wrinkled neck of a woman. In her hand, she gripped an egg-shaped stone. She was crushing grain against a much larger large flat stone. "Teanaste'lle'n", I said, "hello" in Amharic. She smiled and ushered me in. In some silly western way, I wanted to show her I wasn't there to gawk and snap photos. I motioned for the stone. In short order, my muscles ached and my sweat dripped into with the grain. I felt like a first-class fool. I wished I could have told her what dignity I saw in her people. I wanted to discuss how many of us take things for granted and why it sometimes seems that the accumulation of possessions, like a parallel line, never seems to bisect the lines of contentment. I wish I could have asked her about all those television images of despair. No, I see no exotic glamour living a life devoid of running water, electricity, or one with a healthcare net consisting of a single thread. We can argue whether our lives would be richer and we more sensitive healthcare providers were we to spend part of them without material comforts. Or whether this woman's lack of access to first-world medical delivery systems somehow reduces the amount of hope she has for her children or the amount of love she offers knowing they may die before their time. I did know that I could not look at our healthcare system the same way. I knew that what we offered some of our patients in our ICU, at least provided the chance of a life that afforded the possibility of happiness--that Holy Grail of human desire. And I knew that, in large measure, love and caring was not dependant upon what we possessed, what we knew, or what we could achieve.
  14. Chrissamp

    International Nursing - Whew!

    I like the smell of hospitals. I know it's more than a little odd, but, I always have. Maybe it's subconsciously one of the things that caused me to become a nurse. I smell the ammonia and something feels right about it, it puts me in the zone. The zone where I feel I am fighting the good fight for health, for knowledge, for happiness, for those rare moments when I get to be the one that offers the right word at the right time in the face of pain and death. The scrubs, the light green walls, the matching hallways with little cubbies filled with COWS, and vital sign machines, the nursing station sitting in the center of all of it like the command station with the charge nurse sitting there looking grumping as all get it, because let's face it when do charge nurses not look like that? Grumpy charge and all, it feels like coming home and I love it. Today was my first day and it was supposed to be mostly familiar plus a few new scary butterflies because maybe the walls were a little more blue than green and maybe the charting was different than I was used to and maybe I had more patients than I thought I could handle. But that wasn't the problem. There were no green or blue walls, there was no charge nurse, no beeps of Iv's needing to be changed, no, there wasn't even a hospital. Instead, there was me, and a school, and red mud, lots of red mud. It was on my shoes and smeared on the light blue uniforms of the school kids lined up neatly in the lunch line. We filed passed the kids and into our makeshift office, me and my Kenyan colleagues. Steven my fellow nursing colleague, the pharmacist Brenda, and I, and no happy butterflies. I took stock, one table, one chair inside a 12-foot by 12-foot cement building with no roof, dirt floor, no running water. We pulled out our nursing kits slathered on the hand sanitizer and put on brave faces. We worked for an NGO that provided health assessments for kids and dispensed (though the pharmacist) a limited number of drugs and provided referrals to the hospital for cases beyond our limited makeshift clinic. Our task today was to assess thirty-five of these school kids between the ages of four and eight in the next three hours. As the two nurses, my colleague Kevin and I set up the best assembly line system we could come up with including the pharmacist in any tasks she could perform to save us time like weights and heights. The next several hours were a blur of vital signs, and "please step on the scale", "please step off", "open your mouth", "stick out your tongue", "How old are you"? Some kids hid behind each other and wouldn't respond me until my Kenyan colleague told them it was ok, I realized about five kids in that they were a bit shy because I was white. I tried extra hard to smile and not make any sudden scary movement and to not seemed rushed though we were fighting the clock all day. We had about ten kids to when Steven said "it's going to rain." I gave him a funny look and took the HR for the next kid. Steven hadn't spoken a word in hours not related to our task and I didn't have the mental energy for small talk about the weather. Three minutes later. "It's going to rain." This time I said "Oh?" Using exactly the .05 percent of my brain that wasn't engrossed in the task at hand. "Yes, it's going to rain, we need to go." Surprised I said "we can't, we still have several kids left." Steven patiently pointed to the line that used to have several children in it and said no they won't be here either, their parents are coming to take them home. I was startled enough to stop my mad multitasking and saw several parents appear and whisk their children out of line and outside in a matter of seconds and our last two patients be grabbed by teachers and taken outside. I still didn't get it but it packed up my supply bag as I was told, in two minutes we were running the mile back to the gas station where we would catch a ride. We worked in a slum, no cars could get back to where we were. Then the rains hit and I got it - you don't mess with rainy session in Kenya out in the slums there is no place for the rain to go, so you find higher ground. Now. We waited at that gas station three hours before our driver could make it the two miles to get us in rain like that and it took another three hours to get the five miles back to my house that night. But in-between arriving at the school that morning and my house late that evening I found it somewhere -that this is why I do this coming home feeling. When I arrived at the school to assess the children I didn't get that feeling, just the feeling that there was a pile of work to be done and no one but us to do it. But somewhere between arriving at that school that morning and leaving in the panic of the rains I found something I had been missing. Because, somewhere between the mud, and the cement building with no sink and the line of children I realized it was never the smell, the walls, the nursing station, the familiar organization and equipment that I fell in love with when I started nursing. It was the patients. And the black smiley faces and flashes of toothy grins I received when a child realized we were there to help maybe that was when I realized that first dasy are first days and maybe they aren't so different no matter where you are. There are patients, you are nurse and you are there to help however you can with whatever you have. No ammonia, no problem. I can do first days anywhere as long as there are patients.
  15. A midwife is an individual with required training and certified by the board to practice as a midwife. A midwife attends to various gynecology and obstetric cases as well the foetus. Midwife enhances maternal and child health in the global healthcare facility. Adequate and professional proficiency distinguished a midwife from an individual with a short training to reduce maternal and Infant mortality and morbidity. Maternal and Infant mortality and morbidity is high in Africa especially Nigeria. This is due to lack of political will to combat the menace. Midwives are in shortage with poor remuneration which doesn't commensurate with the work midwives delivered. Midwives in the rural area in Africa over-laboured, stressed up and traumatized. Patients and relatives want a midwife to attend to all of them at a time, leaving the nurse under work duress tantamount to error of commission and omission. The infrastructural decay in the primary healthcare centres is a major cause of poor maternal and child healthcare delivery. The midwife makes use of a head lamp or kerosene lamp to take a delivery of a pregnant woman as well as suturing of lacerations. In fact, the lamp is a private property of the midwife. The midwife works at the sterilization department; to ensure all the equipment for delivery and post delivery is made available for use. Once all the sterilized equipment is used, the midwife pleads with the remaining patients for another twenty to thirty minutes for the process of sterilization which include : washing, cleaning, soaking instruments inside disinfectants and boiling then drying the instruments for re-use. When the process is completed the midwife resumes delivery of Labour. Meanwhile, there are complicated delivery which the midwife will institute a referral system. The little available drugs is dispensed to patients. The midwife provides a comprehensive health education on care of the mother and the baby, some months after family planning is established after several counseling. The most terrible situation of it all is no assistant for the midwife, the patient's relative provides assistance based on instructions provided by the midwife. At secondary and tertiary healthcare level where all facilities are available provides some level of professionalism for midwife even though there isn't full autonomy in the care. Midwives in Africa holds the healthcare alive, they are the backbones of the primary healthcare facility. A midwife is a professional trained person that had acquired stipulated knowledge and technical know -how in managing all conditions including pathological of women and foetus. A midwife is accessible, available and adaptable in the rural community, yet they are underpaid, no compensation, no rural allowance and underrated. Highlighted below are possible suggestions to health organisation, health policy developers, Government (Ministry of health) and Non-Governmental Organisation Establish a functional primary health care centre with adequate facilities Staffing : All personnel required in the primary health care should be provided by relevant authority. Midwife should be well paid and compensated. Full autonomy should be given in order not to hinder the effectiveness of midwife service. Midwife should be enough at each centre during each shift to guard against over -laboured Training and retraining should be instituted for midwife.
  16. Olaleye Jemimah

    Am not just a nurse

    Am not just a nurse by profession Have been trained to make it my nature With my meekly tender on motion Blissfully showing the sick my affections Irrespective of their conditions A vow I pledged during my induction I am not just a nurse but a savior A reliever of all souls Medically putting sickness behind the door My scalpel, an instrument of pure Pills, scissors, and more Tape measure, all is pure I am a nurse and a mentor An ever conscious health visitor In and out of the ward I ensure In spite patient's aren't sure Your health care, my venture Health education, is my chore I am a nurse, yet an health inspector Working diligently with the doctors Not like a servant to his Monsieur But a co worker working hand in hand To make you back on your feet Is a must, not an option Consolidate and palpation Till you are back to rehabilitation I am a nurse, that's my call A job I do with all my all With gentle joy throughout my course Telling everyone across the world Showing it big on my wall Am a nurse among all I am a nurse, your humble servant Always at your service with all my might In the morning, day or night Whenever you seem not alright I bring your health back alright Cheers! It's your right! I am a nurse your caring friend Comforting you since all then Through your ailment, injury and pain I encourage, persuade and mend Even when relatives turn you down I am, but always there! I am a nurse, that's my habit Always euphoria to be on feet My white apron is my envious suit Looking good while it fit in I am much proud of my responsibility Oh, God remain ability Nursing is a globally recognized profession! I am a proud nurse, gladly overworked And still underappreciated, mostly motivated While standing to seek motivation. I am the determination and hope for the years to come I may be small, but I build a giant in me. I soar through societal beliefs And move through people's prejudice I am a hero to one, a conditioning to another Yet, no sector stands without me. I am fearless and dedicated For liberation and inspiration I render lots of determination, Power to care and stories to share. Don't test me, am building the eagle in me. Think of it, imagine what nursing will be in the next ten years! Ask yourself, what can I do to restructure nursing and make it reach its climax? Remember we are not just hearers but doers. Don't let us be policy abiders, but policy makers. Let us make this profession stand out among its counterparts. This is the time to stand up and give nursing its credibility and take it to the climax because without nursing, the health sector will be no where to be found in the society. Be delighted in your words and actions as you render the holistic care putting Human Rights into consideration by being fair, show dignity, respect, allow autonomy and equality to patients irrespective of their status, gender,tribe,religion For this profession to move forward, capable leaders are needed to strengthen its professionalism and re-brand its image. Let us soar together as one and give nursing its credibilities. We have been our patients advocates in our interest with doctors and administrations, why not with Congress? Who better to speak to policy makers on behalf of nurses than nurses? Who has a better understanding of what nurses do than nurses? Who is In the best position to address the health concerns of our patients than nurses? If not nurses, whom!? If not now, when? This is the time to speak and to be heard, to hold elective offices,more nurses are needed in the Parliament no one else in the health profession can speak with the voice that we have!
  17. When to start your job search Throughout my training I was constantly urged by mentors in the months prior to graduation to start applying for jobs - "It will be harder/take a lot longer than you think!". Well, take heed, finding a job in the current climate is particularly difficult - in some instances trusts are withdrawing funding for advertised positions, and besides this there are many applicants for each job - competition is tough. If you hope to stay in the area local to where you have studied, remember that everybody in your cohort will qualify around the same time, and you will all be competing for those jobs - you want to be ahead of the crowd. The bottom line is start early. Writing an effective personal statement which will appeal to an employer does take time, thought and practice - if you start thinking about it months in advance and familiarise yourself with the applications process, you will give yourself a head start. Sign up for automatic job updates relevant to your field of nursing on the NHS jobs website so that you have a good idea of what's out there, and start thinking about what kind of area/ward/environment you really want to work in. If you have an ultimate career goal, think about which opportunities will provide you with the most relevant experience and set you on the right path. Before you apply If you have an interest in an advertised position, contact the manager (details will be on the advert) and ask if you can visit the area and arrange to meet with her/him in order to discuss the details of the job. A manager I worked with on my final placement gave me this advice, and in my experience visiting is tremendously valuable to your application; it shows that you are really interested and willing to take initiative - it gets your face known. You will get a feeling for the job role and in many instances have the opportunity to take a tour and familiarise yourself with the area. Remember that in the applications process first impressions count - make the effort to dress practically though smartly and behave courteously, making sure you thank them for taking the time out of their schedule. Prior to the meeting prepare some pertinent questions and write them down to take with you. Consider topics such as what a perceptorship programme entails, what are the current initiatives running in the area, future priorities and goals etc. You will have some practical questions such as expected start dates - but remember to include some questions which portray the fact you have really looked at the job description carefully and taken an interest. Most managers are very pleased to see a visiting applicant and will really take the time to get to know you - so be prepared to talk a little bit about who you are and what you have been doing throughout your course, as well as what you hope to do in the future. Listen carefully to the information they provide and take some notes - this will invariably be pertinent to the interview questions. If you have the opportunity to visit before you apply, you will also have a better idea what to include in your personal statement - sometimes this isn't possible and time is of the essence, but it is still important to visit even if you have already applied. All in all, it can feel a bit daunting - but remember that if you are successful and get an interview, it is likely to be in the same place and with that manager - when would you rather see both for the first time? Writing an effective personal statement Assuming you are applying through the NHS online system, your personal statement will be your only real opportunity to make a personal mark. Most nursing jobs in your field will have some basic key skills and requirements in common - I found it helpful to review several job descriptions and find out what those common features were, and use this to write a basic personal statement relating my relevant placement experiences to those things. You can save this as a word document and then reinvent your basic format each time, adding more details in terms of the more specific skills relevant to the job and focusing on the personal attributes you feel you can offer which will be most valuable in that area. ALWAYS read carefully through the detailed job description, and when proof reading your personal statement tick off the requirements to ensure you have covered each one - if it is very long, it may not be possible to touch on everything, so decide beforehand which are the most important. This is valuable because whoever is short-listing applications is likely to refer to the job description and it shows that you have been conscientious and taken the time to understand their requirements. There are lots of good examples of nursing CVs and personal statements around the web, which can be a really helpful guide - but be careful not to plagiarise. In terms of presentation, make sure you spell check your statement before submitting it and you have used appropriate punctuation and paragraphing. Poor spelling and grammar will give a sloppy impression. Re-read your statement a few times to ensure you have a logical flow of ideas throughout - as a rule of thumb you should start with a brief introduction about yourself and where you are in your studies, and finish with a statement about why you think you would be a valuable contribution to their nursing team. It is a bonus if you can get others to proof read it as they may pick up on mistakes you have missed. All in all you are aiming to write a detailed but concise personal statement which also gives a flavour of your personal qualities and interest in the field. Interview Attending an interview can be a daunting experience for anybody. Thankfully, most band 5 interviews do not require you to make a presentation. Sometimes you will attend a group interview, but in most cases you will be interviewed individually. In almost all eventualities you will be interviewed by a panel rather than a single person. This sounds very daunting but most interviewers are highly skilled at making you feel comfortable within that scenario. Of course, you want to be mentally prepared for the challenge - so if details about the structure of the interview aren't provided, use your visit as an opportunity to ask so that you know what to expect. Preparation really is key to interview success. Expect to be asked to talk a little about yourself - this is often a little vague and open-ended, so remember to keep it relevant to the job and avoid talking about your hobbies unless commenting on a transferable skill. You should think about the point you're at in your studies, what they comprised of, any other relevant work experience, why you wanted to go into nursing and how you feel you have developed. You will almost always in some form or another be asked to talk about your strengths and/or weaknesses - make a short list of each. For every strength consider how you can apply that within the role/how it will add to the team, and an example of how you have displayed that attribute within your placement experiences. Turn each weakness into a strength - 'as a new student I struggled with ...., but I was able to overcome it by ....'. It goes without saying you should choose wisely - this isn't the time to reveal you have a habit of sleeping in. These seem like really simple points, but most people find it really hard to talk about themselves so be prepared. It's easy to get swept up revising different topics, only to find you draw a blank when it comes to more personal questions. Hopefully you have already met the manager by now and have picked up some hints as to what topics might be covered - use this as your guide and read, read, read! Think about and write down the types of questions you might be asked, and memorise the key points you'll hope to cover in your answer - this will help prevent your mind going blank when nerves are at work. Just as important, for each question reflect on an experience from your practice placements (or other work experience) where you have demonstrated that skill or attribute. You want to show that you not only know your stuff, but you understand how and why to apply it, too. Another thing you should look at are any current developments in nursing - key reports and significant reforms. You may be asked about these directly, but even if you aren't, paying reference to current issues shows that you maintain an interest in the direction of the profession as a whole and that you keep in touch with the drives of the NHS or of the trust. This is particularly pertinent when talking about evidence based practice. At the end of the interview, you will be asked if you have any questions for the interviewer. You should ALWAYS prepare some questions to ask - this portrays interest. Never ask about salary in the interview. You may want to cover some practicalities, but cover some topics of interest besides. Good examples of questions to ask would be things such as 'What are the main issues which will be effecting the department over the coming months?'. The RCN interview skills guide (available online) has more examples. Invest in a neat, hard-backed notebook to take along to the interview and write your questions for the panel in that. Don't underestimate the importance of asking questions. I was struck with terrible nerves on the day of my interview, but I was informed as part of my feedback that preparation along with my questions at the end had really swung it for me and got me the job. So, you have done a whole lot of preparation and the day of the interview is upon you. Make sure you allow yourself enough time to get ready without rushing and to have a last minute run through of your notes. When feeling nervous try to take some slow, steady breaths. Remember that nerves are normal in an interview situation, but you only need to hold it together for that period of time. Make sure you know where you need to be and aim to get there in plenty of time. Select an outfit which is smart and professional, but also appropriate to the area of work - for example, in a ward environment, opting for tailored trousers rather than a dress or skirt will look smart and you will also look more 'work-ready'. As with any interview, avoid showing too much skin, clothes which are ill fitting or noticeably well worn, see-through blouses or lots of jewelry. Cover any tattoos, ensure that your hair is neat and opt for natural looking make-up. Wear smart, polished but SENSIBLE shoes. You don't want to be tottering around in high heels which hurt your feet. You could be waiting around for your interview, you want to be cool and comfortable. Stand and sit up straight but be mindful to maintain a relaxed body posture as best you can. Use that 'open body language' you've been practising all these years and don't cross your arms! Bring along your ID on the day (passport/license with paper copy) and if you have it already, evidence of your NMC registration. I have never been asked for a paper copy of my CV but I think it would be wise to bring these along just in case the panel asks for more information about your education and experience. Thinking on your feet can be hard when nerves are at play - the more you can prepare before hand, the better. When entering/leaving the interview room it is appropriate manners to shake the hands of each member of the panel. This can feel quite awkward since most of us in nursing are women and it is an unfamiliar social convention, but bite the bullet and do it anyway. Be confident and make eye contact as you do it. I think the major exception to this would be if you are very familiar with the panel or assess on the day that the tone of the interview is very informal. Lastly, GOOD LUCK! If you you have an unsuccessful interview, remember that competition for jobs is tough and finding a job for anybody in any field at the moment is more about the 'long game'. Request feedback whenever possible and use it to tweak your approach - practice makes perfect. Reflect each time on what went well and what went not-so-well. Whilst you continue to search for jobs, take any opportunities to increase your skills and enhance your CV - you could attend short courses or access voluntary work placements. The nursing departments of most universities run guest lectures open to the public. Above all keep trying and don't lose heart. It won't be long before somebody sees your potential and snaps you up for a position!
  18. I'm packing up to leave. I'm so tired of breathing in smoke, and I miss my kids and I know I have 24 hours of travel ahead of me before I will see them again. As I am giving Beatrice, the matriarch of the school and clinic in which I have been volunteering, a last hug, I feel a light tap on my shoulder. A thin, dusty man is standing behind me. He is with Beatrice's daughter, Fabiola who asks, "Would you have time to see one last wound?" I think to myself, "A person...a human being, not a wound" but that's nurse talk in my head, and I don't share. I motion the man over to a bench and he limps after me. He points to his right foot - he's wearing a black, equally dusty shoe with the part covering his toes cut off. I can see his bare foot, and I can see a large, brown, blob of mud on his great toe. He talks in Haitian Creole to Fabiola and I catch a few words, doulè (Pain), ede mwen (help me) and machete (machete). My Creole isn't great, but I definitely understand machete. Fabiola explains that James was working in the fields last week, clearing brush with a machete and hacked part of his great toe off. It is hurting him, and he needs to get back to work - is there anything I can do? I ask Fabiola if I can have a basin of water and a cloth and while she gets that for me, I run to grab the wound care supplies I think I may need. What would you grab? Do you have a plan in place for dressing the wound you are expecting to see once the mud is washed away? I personally would want the following (at a minimum): 1. Gloves 2. Sterile saline - the kind that comes in a nice spray bottle 3. 4x4 gauze pads 4. Sterile gauze swabs for exploration, if needed 5. Sterile occlusive, non stick dressing (I love xeroform) 6. Tape 7. Bandages for wrapping You have to work with what you have in Haiti, and I had most of the items on the list because we had brought them from the U.S. If we hadn't brought those items, I would have had a basin of clean water and some cloths.It takes about 15 minutes to remove the mud and what I see underneath is a great toe with a chunk missing. The medial upper part of the toe and some of the toenail is just gone. In place of what should be there is a reddish yellow area the size and shape of an elongated quarter, there is pus, and it doesn't smell very good, and some black, necrotic tissue around the edges (do yourself a favor and don't google "machete wound"). Ideally James would have gone to an emergency room or urgent care clinic, where they would have cleaned the wound, closing it if possible, so it could heal by primary intention. He would have been given a tetanus shot if needed, and antibiotics to prevent infection. He would have been scheduled for a follow-up visit. James lives a 1 hour walk from the nearest clinic, which is only open a few hours a day, and which often has a line of 50 people outside upon opening its doors. When he hacked off his toe, he didn't have a way to get to town, and he needed to keep working to support his family. His toe hurt, but he kept working and it eventually became so swollen that he had to cut his shoe to fit it over his foot. James didn't have the opportunity to take the day off, to elevate, rest and recuperate. James did not have access to bandages, or even socks. Now I have James in front of me with an infected wound that isn't healing. I would like to remove the necrotic tissue (not in an RN scope of practice, I know) and support healing by secondary intention with dressing changes and antibiotics. Instead, I applied Xeroform (iodine impregnated petroleum gauze) to the wound, wrapped it in gauze, secured it with tape, and then wrapped his foot in a long strip of gauze, which I secured with self-adherent wrap. I found the NP I was traveling with (who was busy with the million things she needed to do before leaving) and we gave him a week's supply of a broad-spectrum antibiotics (also brought from the U.S.) and asked him to go to the clinic the next day to have the wound cleaned and re-bandaged. Knowing he wouldn't come in all probability, I gave him some wound care supplies and told him to change the dressing every few days, or when soiled, or if it came off. James thanked me and we parted ways and within 36 hours I was back home in the US with all the wonders of modern medicine at my disposal. I have no idea what happened to James. This is a story from my most recent medical mission trip to Haiti. I went in 2011, and then most recently in the fall of 2016 just after Hurricane Matthew. In 5 years, nothing appeared to have changed. I saw the same rubble and fallen buildings, the same deforested, barren, grey, dusty hills, the same grinding poverty. What difference was I making? Yes I was spending American dollars, but did Haiti really need ME? After I got back I had an idea. Why not do something that might actually make a difference? I decided to send a young Haitian woman to nursing school. Haitian women have a life expectancy of 62.8 years, but women in neighboring Dominican Republic live an average of 75.5 years. The infant mortality rate is one of the highest in the world at 630 per 100,000 live births. Women delay seeking treatment due to the time it takes to reach a clinic, the lack of available resources or physicians at clinics, and lack of funds. I came away from my second trip to Haiti with a renewed sense of purpose that if we don't help Haitians make a difference in Haiti, nothing will ever change. The Patient Risk Detection Theory (Despins, et al., 2010)1 states that education and training can reduce harm to patients. Additional research2 shows that when we train WOMEN, we are even more likely to reduce harm. According to USAID3, investing in gender equality and women's empowerment can unlock transformational human potential. Women account for one-half of the human capital in any economy and Haiti is no different. Women make up more than 40 percent of the agricultural workforce, but only 3-20% are landholders. Only 22% of women in Haiti go on to Secondary school, but studies have shown an extra year of secondary school can increase future earnings by 10-20 percent. Countries investing in girl's education have lower mother/baby death rates, lower AIDS and HIV rates and better child nutrition. Polo Mitan, a Haitian Women's Organization, states that when women participate in politics, governments become more open, democratic and responsive4. I chatted with the board of Consider Haiti (the local group I went to Haiti with in 2011)5 and they put me in touch with a 23 year old orphan named Rose Katiana L____. I started a business called Safety First Nursing6 to raise awareness about patient safety issues, and to raise funds for her education. I went ahead and sent her tuition to start school at the American University of Modern Sciences in Haiti in Saint-Marc (just outside Port Au Prince, but 45 minutes by Tap Tap from Montrouise where she lived). Consider Haiti helped me find a room to rent in St. Marc so she wouldn't have to make the long and death defying commute every day. I also sent her to English school (she started last summer). The funds to support Rose for the entire year of school (including room, board, uniforms, books etc... has been $3000), though I am worried because I don't think she gets to eat every day. Rose's first day of school was November 27th, 2017 - here is what she wrote (translated from Creole) How are you going? I write you to tell you I'm really happy for going school. It is the first week of school, the teachers get acquainted with the students. There are amongst our teachers who are advising on the extent of the nurse's career. As a nurse, if you don't know it, the doctor may. I have learned some things about STDs (sexually transmitted diseases) and I have learned some about IST (sexually transmitted infections). I also learn to understand the difference between an infected person and someone who is sick. I learn someone can get infected but not sick. Someone is sick when it comes to signs and symptoms. I hope to learn more because I want to learn. Here is the STD day plan: 1) Definition of word updating STD 2) different types of STDs 3) how the STI transmits 4) Factors that favor the transmission of STDs 5) how to prevent STIs. I will start sending photos and videos of my fellow students. If there is a type of photo you need to ask me to read and send it to you. I am happy to go to school to learn how to work with you. I will never stop thanking you so I can begin to fulfill my dreams. Thank you very much! This is her most recent email to me in late January, 2018 (in English!): How are you? I'm happy to write to you. I've Just taken an exam lately and I'm passed and qualified for the next session. I love the teacher's way of teaching. I feel so good when I' m in the school now. Love you!!!! It is my deepest wish that Rose carries my passion for nursing to the people of Haiti. I am excited to see where empowering her will lead. She is becoming Safety Nurse in Haiti (If you didn't get a chance, you can read the first part of the origin story of Safety Nurse HERE). Please consider supporting medical mission work and real change in Haiti. You can visit Safety First Nursing6 to see pictures of Rose, sign up for my newsletter to get updates and donate to her tuition fund. There are even some CEUs there - all purchase funds go towards her tuition, room and board. Read the complete story: The Origin Story of Safety Nurse: How I Got Here. Pt 1 Safety Nurse in Haiti: A Medical Mission Trip- Origin Story Pt. 2 Healing Machete Wounds with Safety Nurse- Origin Story Pt 3 References 1 Detection of patient risk by nurses: a theoretical framework. - PubMed - NCBI 2 Progress of the World's Women, 2015-2016 United Nations Report 3 USAID Empowering women 4 Poto Mitan - Haitian Women - Pillars of the Global Economy 5 Consider Haiti 6 HOME - Safety First Nursing
  19. Dementia is not a specific disease but it is a general term for describing a decline in cognitive abilities (Alzheimer Association 2017). Dementia depicts a group of symptoms affecting memory, thinking and social abilities severely enough to interrupts daily functioning (Mayo Clinic 2016). According to the Alzheimer's disease International (ADI), the estimated number of people living with dementia is 46.8 million people worldwide and this number will be doubled every 20 years, reaching 74.7 million in 2030 (ADI 2016). Persons suffering from dementia usually suffer from under-recognition and limited capacity to express pain and discomfort and consequently, this affects their quality of life (WHO 2016, NHS 2013). Due to the deteriorating communication abilities within dementia patients, sometimes pain is reflected by different verbal and nonverbal expressions. Frequently, the lacking expression of pain could lead to physiological and psychological distress among patients resulting in what is described by dementia care providers as challenging behavior (McAuliffe et al 2012). Literature highlighted pain as a main reason behind patients' struggle and discomfort (Shega et al 2007, Horgas and Miller 2008). Pain can be caused by chronic conditions such as arthritis and vascular diseases among elderly or other conditions such as pressure ulcer, falls, cancer and post surgical (McAuliffe et al 2012). Signs of pain among dementia patients include distressed facial expressions, agitation, restlessness, anger, discomfort, confusion, crying, limited activities and disturbed sleep (Achterberg et al 2013, Alzhiemr's Australia 2011, Horgas and Miller 2008). However, Horgas and Miller 2008 argued that signs of suspected pain in dementia patients such as vocalization, breathing, and body language could be referred to factors other than pain such as anxiety or cold. They asserted the need to reevaluate the patient several times along different days if one of these symptoms existed. The WHO 2016 alerted that human rights of dementia patients are violated repeatedly due to the frequent use of chemical and physical restraints even when legislation to protect the patients are in place. As a nurse, I recognized from different situations in practice that pain in dementia is not properly assessed or managed appropriately in many occasions. Although I was graduated as a bachelor degree nurse and studied nursing for five years in Egypt, I did not have enough information about pain assessment scales for dementia patients and how to maintain comfort for those patients. Even, I used to assume wrongly that it is normal, sometimes, to find dementia patients agitated, angry, restless, crying and even restrained especially in places as intensive care units. However, experiencing many situations with patients obliged me to search for more information to understand communication challenges with dementia and what might lead to such anger or restless feelings among patients. I felt responsible to develop my knowledge and practice to achieve patient-centered care approach and respond to individualized needs for each patient. One of these situations occurred in an elderly care home where one of the residents who suffered from dementia started to avoid eating or drinking and even cry when food is served. The resident lost her communication abilities for several months and needed help in most activities of daily living because of dementia. Changing food type, time and quality did not help or improve the situation. The care plan for the patient started to include intravenous fluids and a decision was made by the medical team to start nasogastric feeding for the patient. The patient was given antipsychotic medications because of the increased agitation, distress, and restlessness. Finally, during the weekly medical check for residents, the general practitioner discovered an abscess in the patient teeth and that she was suffering from severe pain. This was one of many situations where the pain was at the heart of the scene with dementia but we can hardly recognize it or highlight its effect on patients. Situations from clinical practice influenced my career as a member in the curriculum development committee for health care assistants (HCA) programmes in Egypt. I assumed including dementia and pain assessment should be part of the HCA curriculum to achieve patient-centered care strategies and provide dignified care approach. I also believe that nursing education and HCA training programmes that are taking place in Egypt could be more patient-centered if decision makers and curriculum development specialists have a shared vision on the health care needs and worked to review and update the curriculum based on the upcoming need to service users and feedback from graduates based on their clinical experience. References: Alzheimer's Disease International (ADI). 2016. The global voice on dementia: dementia statistics. [online] available from: Dementia statistics | Alzheimer's Disease International Alzheimer's Australia. 2011. Pain and dementia. [online] available at: Helpsheet-DementiaQandA16-PainAndDementia_english.pdf Alzheimer association. 2017. What is dementia. available from: Dementia - Signs, Symptoms, Causes, Tests, Treatment, Care | alz.org Achterberg, W., Pieper, M., Dalen-Kok, A., De Waal, M., Husebo, B., Lautenbacher, S., Kunz, M., Scherser, E., and Corbette, A. 2013. Pain management in patients with dementia. Clinical Interventions in Ageing, vol.8, no.1, pp: 1471-1482. Horgas, A. and Miller, L. 2008. Pain assessment in people with dementia. Advanced Journal of Nursing, Vol. 108, no.7 NHS. 2013. Managing pain in patients with dementia. Hertfordshire: Clinical Commissioning Group.[online] available from: Mayo Clinic. 2016. Dementia overview. [online] available from: Dementia - Overview - Mayo Clinic McAuliffe, L. , Brown, D., Fetherstonhaugh, D. 2012. Pain and dementia: an overview of literature. International journal of older people nursing, vol.7, pp:219-226 WHO. 2013. Dementia factsheet. [Online] available from: WHO | Dementia
  20. aoguagha

    Tips for Studying Abroad

    Many students try to circumvent the high costs of post secondary education in the United States by studying at overseas institutions. Meanwhile, others pursue education overseas because they believe that the quality of education is higher overseas or because they just want to travel and live in another country. Like many others before me, I chose to study abroad because I wanted to travel and experience another culture but most importantly because the costs of education in the US are too high. Studying overseas meant that the cost of education is 2 to three times less than the cost of schools in the states or free -if you receive a scholarship. As an undergraduate student, I studied at a private intuition in the US and the debt I accrued as a result of my studies will follow me well into adulthood. During those times, I always flirted with the idea of studying abroad, if even for a semester, however, I could not afford it. I spent all of my free time working- just to pay the amount my loans wouldn't cover. The last semester of my senior years, I made a decision to leave the country but didn't know where I would go or how I would survive. I just knew I wanted to do two things: see the world and study. While I was researching places to visit, I figured out a way to realize my dreams of studying and traveling. People do not know that there are scholarships offered by different governments to attend undergraduate and graduate schools in their country. For example, with the Chinese Scholarship Council (China) and the Endeavour Scholarship and Fellowship (Australia), students from all over the world can choose to study undergraduate and graduate programs in certain Chinese and Australian universities. Even the United States offers scholarships for US citizens to study overseas. The Organization of American States (OAS) Scholarship offers a scholarship for students to attend undergraduate and graduate programs in up to 35 North and South American countries- excluding the US if you are a US citizen. Some countries such as Taiwan, Hong Kong, and Indonesia offer only graduate level studies. Many of the aforementioned programs require students to take language courses in conjunction with the Nursing degree. If granted the scholarship, tuition, room and broad, and student insurance are covered. In addition to that, students receive a monthly stipend to help defer the cost of living. And in the case of the OAS Scholarship, round trip airfare will be provided- for all other scholarships recipients may be required to pay for their own airfare. Those looking to fill out an application would be conscious of the deadline dates. The most important thing to remember when studying abroad is that completing a nursing degree abroad does not mean you can automatically practice in the United States. The Nursing laws are different in each state however many require that you: Graduate from an English Accredited RN Program If the language of instruction was a language other than English, the student with a need to take and pass an English language proficiency test such as TOEFL. Take and Pass the National Council Licensing Examination for Registered Nurses (NCLEX-RN) Some states require that nurses who have completed a degree overseas complete a Foreign Educated Nurses refresher course. Get a Basic Life Support (BLS), an Advanced Cardiac Life Support (ACLS) course, or a Pediatric Advanced Life Support (PALS) certification from an accredited American Heart Association (AHA) provider. As a graduate student in China, I have learned that there are highs and lows to living abroad. The lows involve missing family and friend but the highs include being surrounded by different and exciting people. Keep in mind that studying abroad is challenging and that flexibility is the key to survival.
  21. abemwe

    The Inside Culture

    It's now a decade and he is past gone, my inside is that I should care for other insides. I prefer to live with what he used to tell me, "Son the inside matters." I don't want to imagine how two races from that far could meet and produce me... I think the inside mattered very much. It is the 32nd month since I graduated. The outside confront the inside, "Work with your race / culture / community / family only." The humble inside defends with a 3-word quiz, "Which is it?" The outside your home. I only know the world. Meaning anywhere in it is my home. My major role is to attend to the insides. Mummy is old, I only see the goodness of a nurse inside her. She originated from here while dad from far Western. I must consider the inside only. I gonna leave her and attend other insides in other corners of the world. The only I have is for the insides no matter what, where, race, ethnicity. In college, during Anat. class Prof. A used to tell us "Always remember human blood is the same/red underneath the skin....." I liked that. Dad's was, "Son it is good to be born in one side of the earth and live in the other side because you will be able to touch two cultures, compare them and learn new things in life...." Yesterday at night, at 8 pm a pregnant woman entered Baraka (labor/blessing ward). She looked happy and strong. "Are you a nurse? Am in labor" "Have a sit." I welcomed her. I burst into laughter when she started dancing. In nursing, you must laugh-the music of the soul to move on. I thought it was madness, but she went on happily. "Oh! yeah, she is encouraging and sustaining the process of labor." Humbly I took the Hx without disturbing her funny movements. "Penina, I want to examine you to assess the fetus" "Not you male nurse. Only Bob can see my nakedness." I later learned Bob was the father to be. I explained to her that it was my profession which is guided by ethics and human rights. "Penina it's 9:20 pm, no female nurse around-males only on duty. She interrupted, "All of you in the wrong profession-male nurses!!!! Misplaced." Deep in my heart, I knew she was wrong. She needed information and understanding of today's healthcare, it's neither a male nor a female. What matters is how much you care for the inside. Period. The rapport was crucial here. I thought of the variability of the cultures. "Penina I understands, but let's think of what you are carrying. We need to assess the fetus status. We only care for 'the inside.' She thought of my inside, she thought of her and what she was carrying inside." Yeah, ou inside, the inside matters." She gave in. I assessed FHR continuously using EFM. "Penina why didn't you come with Bob?" "Oh! What the inside in you? In our culture, this is for female only. Male should give themselves a break." "Wrong, all should think of the inside-baby," I advised. She turned friendly. we called Bob on night duty in the cotton industry. We discussed the importance of him being around, and he joined us at 1:00 am. We discussed extensively-the psychological and emotional needs to Penina, their two races and cultures-quite different indeed. There was no time to harmonize the two cultures. We managed a great deal concerning the inside in Penina. At 3 am, things were moving very fast, a delivery tray there, Penina with strong pains, this time not dancing but moving violently. I think this is how she perceived pain. At 3:20 a baby girl was extracted. "Penina here is your baby." She made a dull smile. Bob was there looking. I thought he would be jubilant, but it turned out to be a surprise. As I did 'rub up' a contraction, I discovered there was another baby. "Undiagnosed twins," I shouted to other male nurses. Bob was alert once again. We monitored the FHR for another 20 minutes. After 25 minutes we extracted another baby-this time a baby boy. "Penina here is another baby. You see... Boy! Baby boy....." "Thanks 'inside nurse'.Ohhh! Finally a boy. You mean it was inside. Thank god. "She was warm and happy on the face. On the other side of the corridors, bob was jumping, "It's a baby boy, baby boy...it's a...Boy." Penina tuned a soft song from her mouth. It was translated to me meaning "Unexpected 'inside', unexpected blessings in Baraka/blessings ward." Around 8 am I discovered that in PN ward Penina concentrated on the baby boy than on baby girl-eye contacts and breastfeeding was more on the baby boy. It took me another mile to explain the importance of mother-baby relationships; attention should be divided equally for bonding. We advised Bob to seek permission from his place of work to give PN care to Penina. What a culture? Not going to ANC for obstetric ultrasonography-until undiagnosed twins in the labor ward. What a culture a woman don't expect a male nurse to attend to her.That no need for the husband to be around during labor and delivery.What a culture that a boy is more important than a girl in the society. What a culture? My only culture which I will stick to is my inside to care for other insides no matter what, where, race, or ethnicity. The inside culture matters.
  22. marian howe

    Human Like Me

    His wife was a superstitious woman. She believed, as did many Brazilian farmers, that the enfermera formada Americana (college-educated American nurse) would perform some bizarre procedure that would render her lame or sterile -- or both. Her bravery was made evident not only by the fact that she allowed me to originally incise her purulent boil but that she was now returning for follow-up treatment. The wound looked beefy and moist. The red streak snaking into her groin was gone. She could walk now, when but a week ago she had been carried in on her husband's back. I was satisfied the maggots had done their job and was relieved the river had dropped enough to allow a vehicle to take this patient to the nearest hospital. With her permission, I injected her with penicillin, packed her wound with gauze that had been boiled over a charcoal fire and laid a pliant tobacco leaf over the pack. It took several hours to find someone with enough courage to drive over the river but eventually, a Jeep happened by and the woman was safely on her way. The woman and I were of different educational backgrounds and different socio-economic statuses. We held contrasting religious beliefs, too, as my patient's family contained many 'espiritos,' those who donned masks and performed animal sacrifices for healing, good weather, and safe travel. Our methods of communication varied, as did our food preferences and even our clothing styles. Initially, she believed it was possible for me to draw her womb out through the hole in her hip and she refused to stay the night at the aide station, telling me honestly that she feared I would remove her leg while she slept. But ultimately -- courageously -- she trusted herself to my care. Being a nurse allowed me to enter the homes of -- and speak freely to -- those in power in our village. Not everyone trusted me and my "modern" treatment methods. But many did and word eventually spread about the enfermera Americana, bringing in patients from rural areas, patients like the woman with the hip wound. This woman's culture and mine were so different. And yet, looking back at this seemingly insignificant case, I can clearly see that I did not at the time recognize culture as a barrier. A woman in distress is a woman in distress. An infected boil is an infected boil. Does it matter that a patient believes painting an affected leg with river mud will keep away the evil so long as, along with the mud, she allows me to lance the wound and use maggots to eat away the rot? Does it make a difference that her husband placed a cut root in his pocket to prevent me from stealing his fertility when he entered my clinic with his wife on his back? And do I honestly care if the patient's family refused to watch her being transported, fearing that if they watched her leave they would never watch her return, so long as she did allow -- of her own accord -- transport to a facility that would preserve her leg and her life? I was lucky. When I was young, my parents exposed me safely to the world. Men and women of every color and ilk crossed my path. In our family, we had college professors with house servants and ranchers with outhouses. And, yes, there was bigotry and ignorance, as there is in everyone's life. But I learned early that we worry too much about getting things wrong and not enough about making things right. We stew and fret that in our ignorance we may insult someone when we should simply apologize up front for being uninformed and tell our patient what we want to do and why. If the patient consents, we should proceed with professional grace. If the patient does not consent, without guilt or condescension, we must try to find out why. It may be something easily fixed -- facing a window to sleep, not keeping dairy and meat on the same tray -- or it may be something quite complex -- not allowing a woman to touch a man. We may never be able to broach the transcultural barrier we are up against. But it can always be made better through understanding. The outcome is what counts. We are not our patients' parent, spouse, child or sibling. Our duty is to provide respect, not patronization, and treatment, not condemnation. We want what is best for our patient, but we may not agree on how to get there. I believe the solution is fairly simple: Unless a patient's behaviors infringe on the rights or safety of others, we don't need to alter his cultural beliefs to provide competent, compassionate care. Respecting others' decisions about their own choices, even if we disagree, is what matters. Culture is a skin-tight uniform we all wear, from the moment we are born to the instant we die. We are dressed by others in that culture at birth and alter that culture day by day, encounter by encounter, choice by choice. I am not naive enough to say that we are all the same. You and I are very different in many ways. You may say, in fact, that we are nothing alike and have no common bonds. But look deeper. Underneath, you are human. Just like me.
  23. The Liverpool Care Pathway (LCP) is widely used, and recognised as best practice when caring for patients who are end of life. It aim is to guide the multi-disciplinary team in areas such as discontinuation of fluids, medicines and the pathway gives guidence around comfort measures during the last days and hours of life. Organsised into sections, it has provided consistency, support and guidence for those who make use of it to promote and ensure a comfortable, dignified death. The Marie Curie Palliative Care Institute Liverpool In recent months there has been a great deal of scrutiny around the use of the pathway, orginanating from a Daily Mail article by Melanie Phillips who suggested that the pathway has been used to expidite death and without the full knowledge of relatives of dying patients. (I must warn the reader, the Daily Mail is a tabloid paper reknown for it's condemnation of the National Health Service and the UK healthcare workers) The medical profession's lethal arrogance over the Liverpool Care Pathway | Daily Mail Online The original article has caused great anxiety within the healthcare world, not because the information provided is correct but because the scaremongering tactics of this tabloid could potentially lead to end of life patients being denied best practice and subjected to painful, prolonged deaths. There have been concerns voiced on medical forums, in the British Medical Journal and via facebook fictional characters such as the "Medical Registrar", "the Palliative Care registrar" and "the Consultant Vascular Surgeon" I have used the pathway on many occasions, and in fact have on a number of occasions initiated it's use with discussions with the medical teams. I have only once had the experience of a patient who survived after being put on the pathway, it was discontinued when she showed signs of improvment (she was an elderly lady who had fallen, fractured her ribs, had a splenic bleed and had a multitude of chronic illness' ) It was felt she was unlikely to survive. She stopped bleeding and woke up a week after the pathway had been commenced, the comfort drugs were tailed off when she asked for a cup of tea. News analysis: What is the Liverpool Care Pathway? - NHS Liverpool Care Pathway: Relatives 'must be informed' - BBC News In response to the Daily Mail's article the government has responded, demanding that investigations be carried out in areas that have been named as having poor practice, there is a suggestion that healthcare organisations receive money for putting patients on the pathway, there has been an overwhelming response from medics stating that the care pathway is used after full clinical assessment and where the patient is felt to be in the last days of life. News analysis: What is the Liverpool Care Pathway? - NHS There are now genuine concerns that if healthcare professionals suggest the care pathway to families of patients who are felt to be end of life, there will be fear, misunderstanding and there is the real risk that patients will suffer as a result. Descriptions such as the "death Pathway", claims that it is used to expidite death only contribute to add to the misconceptions and further undermine the general public's trust in healthcare professionals. I have been truly saddened to see the assassination of such a helpful, clinically driven and patient focused pathway by a tabloid paper be taken by the government, and rather than getting facts and looking at the evidence behind the pathway, politicians jump on the bandwagon to condemn and give credibility to the scaremongering.
  24. Hi, I just completed my diploma in engineering field, but I just realised that Im still intetested in medic line. Biology is my fav subject as always, but since Ive got a better result in Physics, so then I proceed to study engineering. As my parents both are engineers, so I will have to be an engineer in my family, this sounds normal as everyone follow their parents footsteps. So I just went on to study without asking myself whether I like it or not. After 2 years of struggling in diploma, Ive never think about to proceed my degree in that field. My parents said that if I wanna work in medic line, is either doc or pharmacy. Nurse is definitely not a choice for us. I would like to ask, whats the problem of choosing to become a nurse? Why theres so many pupil keep saying nursing is not a good job,which not hygiene at all, gottta work shift by shift, gonna clean up form time to time. As in my opinion, I doesnt care about what they say, I just wanna serve people, makes pupil happy, works that can saves lives in every minute. This is the job that I wanted. Parents and cousins will say that Im just kidding, Im just wasting time and money to study it, not working in the field that Ive studied. But I thought that Im the one whos gonna proceed my future, live in my future myself, but not them. But if I proceed my degree in engineering, I will regret that I didn't make a choice just for myself, it will be more wasted if I continue to study. What should I do? How can I convince my parents to change their mind and thoughts about nurse? Just because I will be the first nurse in my family so they dont have any reference for me. They just simply dont allow me to study that. Im so frustrated now that I have to make a decision to choose which field to go. Im ready to get scolded by them if I discuss this topic, is just few weeks time for me to decide. But what if Im wrong? I went to school with my friends around, Im happy to be with. We discuss about engineering stuff, but Im the one whos the most quiet when it comes to this session. If someone just ask why I chose this path, my answer is always 'coz I didn't hate or like it, I just chose it.' for no reason. During festival celebrations, many of my relatives will be very busy body asking is my course tough, its obviously tough for me. When they heard the word ENGINEER, they will wowed. I was thinking, is engineering the best for you guys? Why? I saw my cousins talked about their courses, like biotecs, biomedics, architec, etc. They shared their funs ands interest one by one with excitement. My turn, I will just said, erm... Engineer is like that, about leds, lights bla bla bla... No any excitement on me, this is the first time I realised that Im not that interested in my course. Ok next is, after school, I have no other minds to think about my course stuff, Im not curious about the news, the updates. Until my sis told me one thing, she said, hey, why dont you feel curious about your stuff, your future stuff. Shes studying software, she writes codes, and once the software run, she feel curious and excited about it. But I dont really have that kind of excitement when it comes to me. Parents always tell me us to do business in futire, not just to be employed, they dont even ask about my opinion, just ask us to do what are the RIGHT things they thought of. How can I convince them about nursing?
  25. Individuals dream everyday on how to accomplish their milestone, which is to become a senior one day. This can be very challenging for people as nobody knows what the future holds for them. According to Brandon, "There is no clearly defined age when an American becomes a senior citizen" (2010, p. 1). People consider themselves seniors when they retire from their jobs, join America Association of Retired Persons (AARP) or qualify for Medicare. Most countries accept their seniors as those adults at the age of 65 years and above. Seniors, as they get older, do not know where their destiny lies. Some of the older generations live in their homes; visit the centers for seniors to associate with one another, while some find themselves in a nursing home. Where seniors live in United States (U.S), depend on their choices, families, or the community they live in. Nursing homes in the U.S are different from the ones in Nigeria. Nursing homes according to Medline Plus is a place for people who don't need to be in the hospital but can't be cared for at home (2014, p. 1). The majority of people in the nursing homes are older generations because of the use of the long term care unit in the facility. The U.S. has the necessary equipment needed to accommodate these elderly to keep them safe in the community while the less privileged countries, such as Nigeria, are still looking for ways to manage senior homes. The U.S. is one of the best countries in terms of health resources for seniors, based on my experiences, working in the long care facility. This paper will state the differences between U.S. nursing homes and the ones in Nigeria. Culture is the way people live their lives. It can also be seen as a consistent uniformity of lifestyles of an individual in a community. Nigeria has a culture which encourages children to take care of their parents as they get old. Keeping the elderly at home creates a good relationship among family because life is too short. This gives family enough time to spend some time with their loved ones, thus appreciating every moment they have with each other. There are no regrets felt by the children when these elders die because they will never forget the days they had together, which is a memory that will stay with them for a long time. Most Nigerians do not work as many hours as those in the U.S. do. Working less hours gives people in Nigeria enough time to take care of their loved ones as they continue to embrace their culture. This cycle continues in a circular motion as it is passed on from one generation to the other. The admission process for seniors to a nursing home in Nigeria is based on lack of guardianship. The seniors who are accepted to live in the nursing homes, located in the community, must have a proof or findings which indicate there are no family members around to take care of them. This can be in a form of not having a child, those that lost their children or was abandoned by their loved ones. At times, the nursing home may choose to admit those with rich families to support them financially with their project. Nigerian nursing homes are charity funded. The U.S. accepts seniors to the nursing homes based on their health, insurance, personal preferences or family desire. Individuals in the U.S. work many hours in order to accommodate their cost of living. These people have no time to keep the seniors at home because of lack of supervision which can also attract a lawsuit for them if anything ever goes wrong in the home. There is a break in the family relationship of seniors as they leave home to live in a facility. After the survey conducted with the elderly and their family, in one of the health care facility in Meriden, it was noted from the answers from the questions given, that 50% of the elderly refuse to go to the nursing homes, as they believe their families brought them to the home to avoid the responsibility of taking care of them. These seniors, in this situation, from their answers from the questions given, stated how they hate their family for a long time. They leave them with a guilt to judge themselves if the right thing was done for their love ones when they die. The visitations made by the family are no longer on every day basis, but is on the availability of their time. Most seniors in the nursing home believed and felt that a piece of their life was gone because of the disassociation of the family relationship they had with their loved ones. The government understands the frustrations exhibited by the family as their parents go to nursing homes, wants to help the elderly, by keeping them at home, and saving money for the state. This is one of the postulated goals for the year 2020 (Healthy People 2020). They will do this by providing more aides to assist family to take care of their parents and cut down some of their work hours, which gives them enough time to spend together. Nursing homes in the U.S. is mostly funded by the government. The article "Home and Community-Based Medicaid Options for Dependent Older Floridians" stated the high costs of nursing home care have led the state to implement care management alternatives that offer potential for cost savings along with greater consumer satisfaction through maintenance of community residence, (Golden et al, 2010, p. 371). Most nursing homes use the Program of All-Inclusive Care for the Elderly (PACE) as the capital authorized by the Balanced Budget Act of 1997 to assist Medicare and Medicaid financing. The government reimburses nursing home according to state budget. The cost of living for the resident in the nursing home in Florida is approximately $3,839 per monthly (Golden et al, 2010, p. 374). In Connecticut, the average cost for semi-private room is $8,365 minimum, $11,254 median, and $14,904 for maximum care, and higher in private-room occupancy (Skilled Nursing Facilities - Your nursing home resource). The cost of living in Nigeria is zero because of charity donations. Most of the things used to maintain the senior homes in Africa are received from the generosity of people in the community. The funding for the senior homes is from donations from civilians as the government does not have any business with the organization. Donations come in everyday to the facility and is carefully managed to avoid excessive usage or waste. Sometimes the management of the nursing home in Nigeria goes to different companies to ask for essential things that the facility need to be in a functioning state. There are no mandated state rules or regulations for the nursing home in Nigeria to follow as it is not managed by the state. The facility cannot face any lawsuits because everything done for the resident is on a charity basis. The U.S. abides by the rules of the nursing home to avoid fines, which may be imposed for any violations that may occur in the home. This may lead to the closing of a facility or a lawsuit. Individuals who work in the nursing homes in U.S are mandated to take in-services, in which some may be mandatory to keep up with the changes as the world continues to advance with technology. Compliance with the education will facilitate standardization of care to seniors in nursing home in the U.S. During the interview with the resident, it was noted, the residents seen in the nursing home in Nigeria are happy with their care. They express how the workers treat them well, answer their call bell whenever they call for help, and provide clothing for them. All the comments received from the seniors in the facility were positive. There were no negative statements from the people in the senior home in Nigeria. This attitude exhibited by these people, based on the survey, is different in the U.S., as half of the seniors are angry and happy with their perception of nursing homes. They were forced to leave their homes against their will to live in the nursing homes. Some of these seniors believed their family stole from them, took their freedom, and brought them to the nursing home to die. These seniors are often seen at the front door of the nursing home as they always attempt to escape the building. Some of them show some aggressive behaviors towards their family or the caregivers who takes care of them. According to Zeller et al, "An investigation in U.S nursing homes focusing on physical aggression toward nursing assistants revealed that 34% of nursing assistants experienced physical injuries from assaults by residents" (2012, p. 250). These aggressive behaviors exhibited by the resident are mostly from demented seniors because of their cognitive impairment cannot adjust well to the changes in their present environment. The U.S. is still having a hard time helping seniors adjust to their new environments because family participation and involvement in decision making plays an important role to the resident for them to accept all changes towards their continuum of life. Life expectancy of the seniors in Nigeria is lower compared to the U.S. The World Health Organization (WHO) stated, "In 2012, life expectancy at birth for both sexes globally was 70 years, ranging from 62 years in low-income countries to 79 years in high-income countries, giving a ratio of 1.3 between the two income groups" (2015. P.1). According to Ortman et al, "In 2050, the population aged 65 and over is projected to be 83.7 million, almost double its estimated population of 43..1 million in 2012" (2014, p. 1). America is more at an advantage to life expectancy compared to Nigeria because of the high developmental standards it has in regards to health status. Nigeria is still under development and faces a lot of challenges when it comes to health because they do not have all the necessary things needed for the seniors in the nursing homes. Falls is one of the leading causes of deaths found among the elderly. According to Centers for Disease Control and prevention (CDC), "One in three adults aged 65 and older falls each year of those who fall, 20% to 30% suffer moderate to severe injuries that make it hard for them to get around or live independently, and increase the risk of early death" (p. 1). CDC stated also that it costs U.S. in 2013, $34 billion for medical cost settlement for seniors 65 years and older who fell in the health care facility. Safety measures are consistently taken by nursing homes for the caring of the seniors in the nursing homes. The U.S. continues to look for ways to protect their seniors from falling to prevent the consequences associated with falls in the nursing facility. Most workers in the nursing home are mandated to attend a yearly fall competency fair so to decrease the rate of the people who fall in the home. The U.S. keeps statistics, which is followed up by the safety personnel in the department of public health. Nigeria has no falls, which is hard to believe. It is probably because they do not have the techniques to track or monitor the fall rates. The resources such as physical therapy, occupational, speech are easily accessible and available for the nursing homes in U.S. to use. Nigeria has limited resources and tries their best to get the family involved with the care of the elderly. The nursing home in Nigeria has no short term care because those who are admitted are expected to live inside the facility until they die. The U.S. has the doctors coming in to see the residents 3 times a week, while Nigeria depends on the availability of any medical doctor who wants to volunteer their hours to help in the facility. The nursing home in the U.S. averages about 100 beds or more. Nigeria, because it is under developed and managing a facility under charity, does not have enough beds; but averages about 44 beds or less. The call bell system is not attached to a moveable cord, but is on the wall. The nursing homes in the U.S. are much different than the ones in Nigeria. Seniors as different individuals do not have equal rights to health, housing, or entertainment. The government in Nigeria does not have interest in nursing homes because it does embrace the culture of the people as they prefer to keep these seniors in their home. The seniors in the nursing home in Nigeria are happy and thankful for the opportunity to live a normal life like others. Thanks to the generosity of good civilians of the country, who have been donating money and items for the up keeping of the resident; Most Nigerians believed that the U.S. has many opportunities for the seniors. In the year 2020, the U.S. is looking towards keeping seniors in their homes with their family by providing all the necessary tools, which are needed for their care. This postulated goal has caused a decrease in the rate of admitting seniors in a nursing home, which will help the government to cut down on nursing homes spending thereby saving the state's budget, and keep the seniors happy too. References Brandon, E. (Speaker). (2010, April 13). U.S News & World Report [Audio podcast]. When Do You Become a Senior Citizen Centers for Disease Control and Prevention. (2015, March). Costs of Falls Among Older Adults. Golden, A. G., Roos, B. A., Silverman, M. A., & Beers, M. H. (2010). Home and Community-Based Medicaid Options for Dependent Older Floridians. The American Geriatrics Society, 58(2), 371-376. Healthy people 2020. (2015, March). Retrieved from Healthy People 2020 MedlinePlus. (2014, November 13). Nursing Homes. Ortman, J. M., Velkoff, V. V., & Hogan, H. (2014, May). An Aging Nation: The Older Population in the United States. Retrieved from Census.gov Skilled Nursing Facilities. (2015, March). Nursing Home Costs. Retrieved from Nursing Home Costs - Skilled Nursing Facilities WHO. (2015, March). Life expectancy. Zeller, A., Dassen, T., Kok, G., Needham, I., & Halfens, R. J. (2012). Factors Associated with Resident Aggression Towards Caregiver in Nursing Homes. Journal of Nursing Scholarship, 44(3), 249-257.

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